What is the difference between normal ct and enhanced ct?

What is the difference between normal ct and enhanced ct? Ordinary CT examination, also known as plain scan. The inspection method is that the patient removes the metal objects such as metal buttons, necklaces, keys, coins, etc., from the inspection site, and usually lies on the inspection bed so that the inspected part of the body is located in the center of the scanning field, and controls the movement of the bed so that the inspection site enters the hole of the scanning frame Inside, set the scanning baseline and the moving position of the bed, you can scan the positioning map. Select the slice thickness, slice distance, scanning gantry tilt angle according to different inspection sites and different lesions, and determine the scanning range on the positioning map. The spiral CT scan also needs to set the pitch, and then start the layer-by-layer scan or spiral volume scan until all The parts to be inspected must be scanned. The slice thickness and slice distance of the plain scan are usually 5mm or 10mm according to different inspection sites. Multi-slice spiral CT is often reconstructed after thin-slice volume scanning, such as scanning thickness 0.5mm, 1mm or 2mm, reconstruction thickness 5mm or 10mm. The orientation often adopts the transverse plane. Sometimes direct coronal scanning is possible to examine brain and head lesions. Multi-slice spiral CT can reconstruct the coronal plane with volume data obtained from cross-sectional scanning. During the CT scan, the patient should remain still, because motion can produce artifacts and affect image quality. The patient’s braking can be fixed with a fixing strap. Ordinary CT mainly plays a role in screening, for example, like chest CT, general plain scan can basically find early lung cancer. If you need to check for intracranial hemorrhage, the lesion can basically be found on CT plain scan. If CT plain scan suspects cerebral infarction or brain tumor, enhanced CT or magnetic resonance can be done for further evaluation. CT plain scan scans quickly and is used more in emergency departments. CT enhanced scan: This test requires intravenous injection of iodine contrast agent, such as iohexol, iodofluranol, etc. The contrast agent circulates through the blood throughout the body, and the blood vessel contains high concentration of iodine contrast agent, which can be used for vascular diseases The diagnosis of the disease, as well as the evaluation of the blood supply arteries and draining veins of the disease. In contrast-enhanced CT, the scan will be performed according to the time requirements of the arterial phase, venous phase and delay phase after injection of the contrast agent. The contrast agent is first developed in those areas where the blood vessel supply is abundant, and these areas are called enhancement. Because the diseased tissue and the normal tissue have different enhancement characteristics, and the degree of enhancement of the diseased and normal tissues is different, it will increase the density difference between the two, and find the lesions that cannot be found during the plain scan. For example, liver metastases from lung cancer can only see low-density images of the liver during plain scan, and the nature cannot be determined. However, when doing enhanced CT, the description can be seen: multiple low-density lesions can be seen in the liver, and the arterial lesions can see edge ring enhancement. Consider metastasis. The scope of application of enhanced CT is very wide, and it can check for brain trauma, cerebral infarction, brain tumor, pericardial tumor, pericardial effusion, lung trauma, infectious disease of the lung, lung tumor; for solid organs, liver, gallbladder, Tumors of the spleen, pancreas, kidneys, adrenal glands and other organs, and various diseases of bones and joints can be examined. Enhanced CT is mainly used for some diseases that cannot be diagnosed effectively by plain scan to make further diagnosis. For lung cancer, an enhanced scan is usually done before surgery to observe the condition of the mediastinal lymph nodes, hilar lymph nodes and the relationship between the tumor and the surrounding blood vessels, which is more conducive to preoperative evaluation and staging. The scanning period of plain scan and enhanced CT is different. The plain scan ends with one scan, while enhanced CT often requires multiple scans. After the contrast agent is injected, there are many different time periods (arterial phase, venous phase, and delayed phase). For this scan, due to the long scan time, the amount of radiation received is higher than that of CT plain scan. A very small number of patients may be allergic to iodine, and the contrast agent is eventually excreted through the kidneys. Therefore, people with iodine allergy and severe renal insufficiency cannot do enhanced CT. After the enhanced CT examination, you must drink plenty of water to speed up the excretion of iodine contrast agent from the body.

Disease Popularization-Arachnoid Cyst

&nbsp.&nbsp.&nbsp.&nbsp.&nbsp.&nbsp.&nbsp.&nbsp. Arachnoid cyst, also known as leptomeningeal cyst, is a congenital benign brain cyst lesion caused by abnormal arachnoid division during development. The cyst wall is mostly arachnoid, neuroglia and pia mater. There is cerebrospinal fluid-like cyst fluid in the cyst. Cysts are located on the surface of the brain, split brain and cistern, and do not involve brain parenchyma. Most of them are single shots, and a few have multiple shots. The disease is mostly asymptomatic, and large patients can compress brain tissue and skull at the same time, which can produce neurological symptoms and changes in skull development. This disease is more common in children and adolescents. It is more common in men and more common on the left side than on the right side. 01 Clinical manifestations&nbsp.&nbsp.&nbsp.&nbsp.&nbsp. The onset of this disease is insidious and mostly asymptomatic. Some large arachnoid cysts may have clinical manifestations similar to those of intracranial space-occupying lesions. Such as headache, epilepsy, nausea and developmental delay. 02 Inspection&nbsp.&nbsp.&nbsp.&nbsp.&nbsp.&nbsp. The routine application of CT and MRI can generally confirm the diagnosis. Only in a few cases, for the midline part of the suprasellar and posterior fossa lesions, the application of cerebrospinal fluid contrast agent or flow measurement inspection. 03 Treatment&nbsp.&nbsp.&nbsp.&nbsp.&nbsp.&nbsp.Most scholars believe that those without mass effect or clinical symptoms do not need surgery regardless of their size and location. For symptomatic patients, surgical treatment is required to decompress the cyst and remove the cyst wall. The treatment methods include: 1. Drain the cyst, cyst-peritoneal shunt, drain the cyst fluid into the abdominal cavity; 2. Cut the cyst wall, Craniotomy to remove the cyst; 3. Drill or acupuncture to aspirate the cystic fluid. Key points 1. A congenital malformation commonly found in the middle cranial fossa, pons and cerebellar triangle, suprasellar area and posterior fossa. 2. Usually discovered by accident. 3. Skull changes are common, and CT and MRI signals are mostly the same as cerebrospinal fluid. 4. Recommendations for accidentally discovered arachnoid cysts in adults: Perform imaging examinations every 6 to 8 months except for enlarged lesions. If symptoms occur, further examinations can be performed.

Chocolate cysts and adenomyosis

&nbsp.&nbsp.&nbsp.Ovarian “chocolate cyst” and adenomyosis are both diseases caused by endometriosis. Adenomyosis is a common disease that mostly occurs in women over 40 years of age. It refers to the presence of endometrial glands and stroma in the myometrium, accompanied by compensatory hypertrophy and hyperplasia of surrounding muscle cells. According to the distribution characteristics of myometrial lesions, adenomyosis is divided into diffuse type and localized type. When the uterus with adenomyosis was opened, the uterine wall showed obvious thickening and hardening of the muscle layer, thick muscle fiber bands and microcystic cavity in the muscle layer, and occasional old blood in the cavity. Among the sonographic manifestations of adenomyosis, the most characteristic manifestations are: uneven echo enhancement of the affected muscle layer, with disordered punctate or cord-like strong echoes, with honeycomb-like small hypoechoic areas (corresponding to pathological anatomy) (Upper microcapsule cavity), sometimes small anechoic areas of only a few millimeters in diameter are scattered. In addition, cystic adenomyosis, this special type of adenomyosis is clinically rare. Its symptoms are similar to those of classic adenomyosis, and its symptoms are similar to those of classic adenomyosis. Hemorrhagic cystic lesions in the myometrium. Because the disease is rare, it is easy to be misdiagnosed clinically.

What should I do if the condyloma acuminatum relapses within two months after laser treatment

  Through clinical practice, it can be seen that the recurrence time of condyloma acuminatum can be 2 weeks, months, years, and even individual reports for decades. According to statistics of some recurrence cases at home and abroad, it is shown that the recurrence interval of 85% of patients with condyloma acuminatum is about 1-2 months. Laser is a physical therapy. Although it can quickly remove local diseased tissues (“warts”), it is difficult to remove the HPV virus from the spinous layer and basal layer of the epidermal cells. It is a method to treat the symptoms and not the root cause. The HPV virus remains It is the root cause of the recurrence of genital warts.     Many patients with condyloma acuminata will have the experience of recurrence after treatment, so the first treatment of condyloma acuminata is particularly important. If the first treatment is done more thoroughly, it should be able to prevent the recurrence of condyloma acuminata. So I should find a professional medical institution to treat myself. Nanjing Youjia Virus and Wart Medical Research Institute adopts the “2011101665723” invention patent Chinese medicine prescription (which can be inquired by the State Intellectual Property Office), which targets various condyloma acuminata lesions, including the cavity (such as: oral cavity, urethra, cervix, anus, etc.) ) The cure rate is very high. Treating both symptoms and root causes of traditional Chinese medicine is the foundation of the motherland’s medicine, and it is also unmatched by Western medicine.

What are the common extrahepatic manifestations of viral hepatitis

1. Skin lesions. There are often allergies in the early stage, such as urticaria and angioedema. Chronic hepatitis B may have erythema nodule. 2. Arthritis. The joints involved are usually single or multiple. It is more common in the wrist, elbow, and knee joints, without severe pain, which is quite similar to migratory rheumatoid arthritis. 3. Cardiovascular disease. May appear myocarditis, pericarditis, nodular periarteritis, etc., which may be caused by hepatitis B virus directly invading the cardiovascular system. 4. Kidney disease. More common. Early proteinuria, hematuria, and even granular casts, forming immune complex nephritis. 5. Digestive system. In the early stage of hepatitis, gastrointestinal mucosa may have inflammatory changes, so there are epigastric discomfort, nausea, vomiting, etc. Intestinal mucosal edema often occurs in chronic hepatitis. In addition, biliary infections are also common. 6. The blood system. Hemolytic anemia, aplastic anemia, etc. 7. Pancreatic disease. The most common is acute edematous pancreatitis. 8. The nervous system. Such as transverse myelitis, cranial nerve palsy and so on.

Doctor I have been infected with HPV16 for 2 years, and the leucorrhea test has no lesions. I asked for a biopsy. The doctor said it is unnecessary. It is recommended to review it every 8 months. I live in Italy. Now I am very worried. May I ask the doctor what else I need to do? ?

Doctor I have been infected with HPV16 for 2 years, and the leucorrhea test has no lesions. I asked for a biopsy. The doctor said it is unnecessary. It is recommended to review it every 8 months. I live in Italy. Now I am very worried. May I ask the doctor what else I need to do? ? @皮科高广程主任&nbsp.&nbsp. Routine laboratory tests for leucorrhea are mainly used to check inflammation, bacteria, and other diseases, but can’t check whether there are lesions in the cervix. HPV16 is a type that is directly related to cervical cancer, and you have not turned negative for two years. The biopsy recommendation is still to be checked. The biopsy can accurately feedback the extent of your cervical lesions. @ Sina爱问医生&nbsp. As far as I know, although medical treatment abroad is advanced, the examination is more difficult. You need to make an appointment. You can make an appointment for a biopsy. If the cervix is ​​normal, you can use some interferon suppositories and check back regularly. Look. If there are lesions, it is recommended not to wait and actively treat them to avoid the possibility of cervical cancer in the later stage. #中国医生节#&nbsp.#夏健康打卡##夏科普夏令营#&nbsp.#名医服务月#&nbsp.

Director Chen Qian’s popular science sharing of difficult medical records

Today I am sharing a patient from 301 Hospital. The patient was diagnosed with bladder tumors in the United States and Japan and received total cystectomy at 301 Hospital in April 2020. At the same time, he underwent ileal replacement bladder surgery. After the operation, the patient had left ureter shedding after replacing the ureteral stent, and then underwent percutaneous drainage of the left kidney. At present, patients mainly suffer from waist pain, abdominal wall pain, and falling feeling behind the anus. During the re-examination, a solid nodule was found in the pelvic cavity. PET/CT found that the mass was high in intake. Consider the pelvic metastasis. Due to the deep location of the lesion and the nodules of the lesion are not typical, the patient mainly wants to clarify the nature of the nodule to our clinic. Judging from the current data, the nature of the lesion is still highly suspected to be a metastatic tumor. Because the tumor is close to the intestine, the patient has a history of surgery, the risk of traditional surgical resection is high, and there are many complications. At the same time, intra-abdominal adhesions may be serious and the operation is more difficult. Large; if the lesion is treated with radiotherapy, because the lesion is close to the intestine, it will also affect the dose of radiotherapy, which may not be effective; our center mainly uses Haifu focused ultrasound ablation treatment, but after preoperative positioning, it shows that the front of the lesion is intestine Road, the lesion is not well exposed, the display is not clear, and it is not suitable for Haifu focused ultrasound ablation. However, radiofrequency ablation, microwave ablation, and cryoablation with argon-helium knife cannot be performed because of the special location of the lesion. For this patient, our plan is to puncture under the guidance of CT to obtain pathology and confirm the diagnosis; second, under the guidance of CT, the tumor can be injected with PEI lipiodol, chemical ablation, or direct injection of anti-tumor drug. &nbsp.&nbsp.&nbsp.

Is the sore throat related to the kidneys?

Under normal circumstances, there is no inevitable connection, but there are some special cases. Common causes of sore throat. Most of the sore throat is mainly caused by some problems in the throat itself, such as tonsil infection, some inflammation of the throat, and the compression of tumors in the throat. Wait for these direct factors. These reasons are not directly related to the kidneys. If the kidneys have some problems, they will not directly affect the throat. Occasionally, some kidney diseases will indirectly affect the throat, such as chronic kidney disease or some unexplained immune kidney diseases, which may indirectly lead to some inflammatory lesions of the tonsils. This situation is more because the same factor causes the throat and kidney disease at the same time, rather than the simple kidney disease affecting the throat. The case where the kidney directly affects the throat As mentioned earlier, kidney disease basically does not directly affect the throat, but everything is accidental. I saw a case-related case in the New England Journal of Medicine in the previous issue. Main content: A 46-year-old male patient experienced voice changes and painful swallowing. The course of the disease was 3 months. He was admitted to the otolaryngology department and found vocal cord lesions during laryngoscopy. As shown in the picture, some tissues were taken for pathological examination and pathology The result was renal clear cell carcinoma. CT examination revealed that the patient had a 7*6.4*6.6cm mass on the upper pole of the right kidney, and there were also spreading metastases in the lungs. Finally, he was diagnosed with renal clear cell carcinoma. This patient finally chose radical nephrectomy plus adjuvant sunitinib targeted therapy. After a one-year follow-up, the patient’s condition was stable, and some of the lung metastases became smaller. It is recommended to summarize the throat discomfort first to consider the disease of the throat instead of the kidney problem. This transfer method is very rare. If you have a throat discomfort, you don’t have to worry about whether you have kidney cancer. You should check the condition first. It’s the right thing to prescribe the right medicine instead of worrying about some small probability events. Just like people want to make money and make money, the first thing they think of should be to work hard to make money, not to buy lottery tickets. Although buying lottery tickets can also make money, it is a small probability event after all, and one cannot focus on small probability events.

I did the leep knife last month. I was Hpv16 and 52 positive. At that time, the examination found that the cervix had mild CIN1 lesions. What kind of treatment is needed now?

#医生间故事#&nbsp.&nbsp.&nbsp. Patient’s question answer: Director, the leep knife done last month, I was Hpv16, 52 positive. At that time, the examination also found that the cervix had mild CIN1 lesions. What treatments are needed now? @皮科高广程Director&nbsp.&nbsp.&nbsp. Cervical LEEP knife is mainly used to treat cervical CIN lesions, and it has no therapeutic effect on HPV16 and 52 positive. CIN is the result of HPV infection. Only the lesions are treated, the virus will still exist, and new lesions may appear later, so the treatment plan given to you by your doctor last month is not perfect. # Not only can it kill the virus, it also has a therapeutic effect on the disease. The above questions are real questions from patients, and the answers can help everyone gain health knowledge about HPV. #名医服务月#&nbsp.#夏健康打卡#&nbsp.#夏健康指南#

Collection of questions from patients’ family members

Frequently asked questions and answers in outpatient clinics are some frequently asked questions, hoping to help you solve the problem. Parents’ questions: Is hemangioma serious? Can it go away on its own? Answer: Hemangiomas have the dual characteristics of malformation and tumor. They are divided into two categories: hemangioma and vascular malformation. They are benign diseases, ranging from “birthmarks” to endangered A large group of diseases of vital diseases. Lesions can occur in any part of the human body. Due to the nature, location, and size of the lesions, it can lead to abnormal appearance, clinical discomfort and even dysfunction. Only a small portion of capillary hemangioma will go away on its own, and most hemangioma will not go away on its own.  Parents’ question: Should our baby’s hemangioma wait for observation or be actively treated    Answer: Hemangiomas usually do not exist at the time of birth, and about 70-90% appear within one month. 9 to 12 months after birth is the period of rapid proliferation of the disease, which can subside at a rate of 10% per year. After the untreated tumor subsides, 25%-69% of children have residual skin and subcutaneous tissue degenerative changes, including scars, atrophy, hypopigmentation, telangiectasia and skin sagging. In addition, there is a congenital hemangioma that does not go away, which does not go away on its own. Whether hemangioma needs active intervention and treatment depends on the comprehensive evaluation of multiple factors such as the location of the lesion, the development speed, and whether there are complications.  Parent question: Under what circumstances must you take your child to see a doctor?   Answer: You must take your child to see a doctor if you have the following conditions: special growth site, unclear diagnosis, large hemangioma, rapid growth, or hemangioma with other symptoms. If your child has multiple hemangiomas, you must see a doctor to rule out whether there are hemangiomas in the internal organs, including the liver and digestive tract. Hemangiomas in these areas are more dangerous and require treatment. If the hemangioma affects the child’s breathing, hearing, vision or diet, go to the hospital immediately. Recommendation: Early detection, early inspection and early treatment of hemangioma should be achieved. Parents’ question: I’ve never heard of hemangioma before. What kind of department should we give to our children?    Answer: There are very few medical institutions nationwide that specialize in hemangioma, so many parents don’t know which department their children should get. The reason for the irregular treatment of most patients with hemangioma is here. It is recommended that patients go to a specialist hospital for hemangioma.   With the advancement of medical technology, hemangioma specialist hospitals have gradually emerged. The hemangioma specialist hospital is a hospital that specializes in treating hemangioma, so that patients with hemangioma can receive regular and professional treatment, effectively avoiding misdiagnosis and treatment.  Parents’ question: When the baby is just 3 months old, will the baby be painful during treatment? Will there be scars after treatment?   Answer: Appropriate and reasonable treatment can effectively reduce the occurrence of pain and scars. Minimally invasive treatment is recommended.

How is scleroderma diagnosed? The latest guide is here

Is skin swelling a scleroderma? Is skin darkening scleroderma? How is scleroderma diagnosed? The latest version of the 2019 guide is here. Systemic sclerosis, commonly known as scleroderma, often starts with Raynaud’s phenomenon. Gastroesophageal reflux may be combined in the early stage of the disease. As the course of the disease progresses, the patient gradually develops skin swelling and hardening, which may be accompanied by skin pigment changes, including hyperpigmentation or depigmentation. In addition to skin involvement, patients with scleroderma are often accompanied by symptoms such as joint pain and myalgia, as well as finger ulcers and telangiectasia. In addition, patients with scleroderma may have multiple internal organ involvement. The respiratory system is more susceptible to involvement, mainly manifested as pulmonary interstitial fibrosis and pulmonary hypertension. The digestive system of patients with scleroderma has various manifestations, including gastroesophageal reflux, antral vasodilation, abdominal pain, diarrhea, constipation, and fecal incontinence. A small number of patients may have renal crisis, which is mainly manifested as acute renal insufficiency, and often complicated by hypertension. Heart involvement can be manifested as pericardial effusion and cardiac conduction system abnormalities, and individual patients may have myocardial involvement. In terms of the nervous system, peripheral nervous system involvement is more common, such as trigeminal neuropathy, peripheral neuropathy, etc., and central nervous system involvement is rare. CREST syndrome is a special subtype of scleroderma. The clinical manifestations include calcium deposits, Raynaud’s phenomenon, esophageal dysfunction, digit (toe) sclerosis, and telangiectasia. Such patients are often accompanied by anticentromere antibodies (ACA) positive. According to the SSc classification criteria issued by ACR/EULAR in 2013, when the total score is greater than or equal to 9 points, it can be classified and diagnosed as systemic sclerosis. The skin lesions of systemic sclerosis can be divided into three stages from the course of the disease: ① Swelling stage: Early skin swelling, shiny, tightness, non-pitting, hard swelling, fingers can be “sausage finger” change. ② Hardening period: The skin gradually thickens and hardens, indicating that it is smooth and leather-like, wrinkles disappear, not easy to pinch, and hairs are reduced. Facial skin is affected, radioactive grooves appear around the mouth, lips become thinner, and the nose tip becomes sharp, showing a “mask face”. ③Atrophy: the superficial dermis becomes thin and brittle, the epidermis is loose, and the subcutaneous soft tissue is calcified. There is less sweat at the lesion and hair loss. In the swelling and sclerosis phases, most patients’ skin lesions can be reversed or improved to avoid entering the atrophy phase.

How to choose the timing of treatment for scleroderma with interstitial lung disease?

Interstitial lung disease takes diffuse lung parenchyma, alveolar inflammation, and interstitial fibrosis as the pathological basic pathological changes, with active dyspnea, diffuse infiltration shadows on chest X-ray, restrictive ventilatory disorders, reduced carbon monoxide diffusion (DLCO) function and Hypoxemia is a clinical manifestation. Early screening of scleroderma with interstitial pneumonia can detect early, reversible, normal or slightly impaired patients, through immunosuppressive therapy for scleroderma and anti-fibrosis therapy for lung interstitial lesions , Effectively prevent and even reverse the pathological process of interstitial pneumonia, thereby improving the prognosis of patients. The 5-year survival rate of patients with scleroderma and interstitial lung disease is about 90%, and 12% to 16% develop chronic respiratory failure or severe restrictive lung disease.   Therefore, the first challenge for clinicians is which patients with ILD need active treatment, and which patients are expected to benefit from immunosuppressive therapy more than the damage caused by treatment, so as to avoid overtreatment. Generally speaking, the intensity of treatment is mainly determined by the severity of the disease and the risk of progression.   First, assess whether the patient has an inflammatory state. Inflammatory lesions can be reversed, and early treatment is necessary. The evaluation of the inflammatory state includes many aspects, such as the presence or absence of joint swelling and pain, the increase in inflammation indicators, lung function and imaging changes (such as ground glass shadow, patch shadow, consolidation shadow, fiber stripe shadow or honeycomb shadow, etc. ), bronchoalveolar lavage fluid (BAL) and lung biopsy can also be used for evaluation. Second, assess the degree of disease progression.   Studies have found that SSc-ILD progresses the fastest in the first 4 years after the onset, especially in the first 2 years, the degree of lung function decline is the most important indicator of disease progression. In addition, according to the course of the disease, clinical manifestations, modified Rodman skin score (MRSS) score, high-resolution CT (HRCT) score, etc., there are of course some indicators that indicate disease progression, such as anti-topoisomerase antibody positive , High IL-6 level, etc.   Patients with scleroderma combined with subclinical pulmonary interstitial disease do not necessarily need active treatment. If the patient’s inflammation is severe and the disease progresses rapidly, an active and powerful treatment plan should be adopted, combining hormones with immunosuppressants; if the inflammation is mild, the disease is mild or the fibrotic lesions are the mainstay, hormones or immunosuppressants and Anti-fibrosis treatment. Patients with scleroderma and interstitial lung disease need long-term management. In addition to emphasizing regular follow-up and taking medications, professional life guidance and psychological guidance are recommended, including pulmonary rehabilitation, oxygen therapy, and gastroesophageal reflux. Treatment, smoking cessation, vaccination and avoidance of infection.

Uterine cavity preparation before embryo transfer

In the process of IVF treatment, good seeds (high-quality embryos) and good soil (uterine environment) are the two key links for successful conception. How to improve the intrauterine environment, increase endometrial receptivity, and increase The success rate of IVF is one of the goals that clinicians are pursuing. People come up with various plans to prepare the uterine cavity for embryo transfer. Let us learn about the common methods currently available.  The success of IVF technology depends on embryo quality and endometrial receptivity. With the continuous development of assisted reproductive technology, the rate of obtaining high-quality embryos has been greatly improved, but the implantation rate is still relatively low. At present, the implantation rate of embryos on the third day is only 35%, and 2/3 of the embryos transferred are The inner membrane is rejected or lost. Synchronizing the development of the embryo and transforming it into the endometrium that is receptive to the embryo in time is a key step for embryo implantation.   Therefore, before the embryo transfer, doctors have come up with many ways to prepare the uterine cavity, hoping to increase the success rate by “cleaning the house” and “turning over the soil”. What are the methods to prepare the uterine cavity before transplantation?   1. Uterine cavity preparation. Since embryo implantation is an invasive and traumatic process, proper scraping and stimulation of the endometrium before transplantation may stimulate the endometrium The local immune response makes it easy to accept embryos. It can be performed during the luteal phase of the previous cycle, early menstruation, or even on the day of egg retrieval. Generally, use a probe, a disposable suction pad, or a small curette to gently stimulate the uterine cavity, without requiring a full scrape. Because it cannot visualize the shape and pathological changes of the uterine cavity, it has a certain degree of blindness, so it is suitable for people who have not found abnormalities in the uterine cavity by ultrasound. 2. Hysteroscopy is very important to evaluate the shape of the uterine cavity before IVF treatment. Hysteroscopy can directly and comprehensively observe the lesions of the endometrium and the morphology of the uterine cavity, and can process the diseased endometrium. For example, polyp curettage and separation of intimal adhesions can effectively improve IVF pregnancy rate, which is a common clinical examination and operation. Clinical studies have also found that the “soil loosening” (finishing) under hysteroscopy is significantly better than blindly scraping and finishing the endometrium. 3. Laparoscopy: Observe the pelvic organs under laparoscopy. For lesions with moderate to severe hydrosalpinx, the diseased fallopian tube can be blocked or removed, which can effectively prevent the backflow of hydrosalpinx from affecting the uterine cavity and improve embryonic performance. The success rate of the bed reduces the probability of miscarriage. For patients with endometriosis, the lesion can be burnt and washed to reduce the interference of abnormal cytokines secreted by the ectopic lesion on the planting environment. It can also find lesions that cannot be detected by ordinary clinical examinations, such as pelvic tuberculosis. 4. Fallopian tube sticky blockage The fallopian tube is blocked with a sticky block. It is suitable for cases with hydrosalpinx but severe pelvic adhesions, but laparoscopic surgery is difficult, or the ovarian function is significantly reduced. The pelvic cavity and surgery may affect the blood and further reduce the ovarian function However, the influence of the sticky block on the embryo during the operation is uncertain, and the accumulation of water in the fallopian tube cannot be eliminated. 5. Uterine cavity perfusion is currently commonly used in clinical practice such as HCG (chorionic gonadotropin), autologous lymphocytes, granulocyte colony stimulating factor and other perfusion schemes. HCG uterine perfusion is commonly used, but its clinical efficacy is uncertain, and some are considered effective. Some are not considered effective. If there is no other way, you can also try.   The above inspections can be used alone or in combination. For example, in cases of hydrosalpinx combined with endometrial lesions, combined hysteroscopy and laparoscopy can be used to solve two problems at the same time. Due to the different purposes of the examination, the suitable people are also different, so blind treatment is not allowed. For people with lesions in the uterine cavity by ultrasound, there is no doubt about the efficacy of hysteroscopy, but it is questionable whether hysteroscopy is a necessary examination item for all IVF populations, and when it is carried out is also very different.   In any case, I wish all infertile patients can get what they want and get pregnant successfully.

How long is the incubation period of female genital warts

   Most clinical observations of patients with genital warts show that the incubation period of genital warts is usually about 3 months, but some of them can be as short as 2-3 weeks, but the incubation period can be as long as 8-12 months. In addition, it is further confirmed from the survey results that the incubation period of genital warts is about 3 months.   When condyloma acuminatum develops to a certain extent, small herpes will appear on the patient’s genitals, anus and other parts, which are shaped like cauliflower, and the patient feels itching, odor, and pain. This is a more obvious feature of genital warts. Most of the patients with condyloma acuminatum are young people, the proportion of women is more than that of men, and the condition of female patients is more concealed and difficult to detect than male patients, because in many cases the onset of condyloma acuminata is in the cervix, which is generally difficult to detect To. For those with unobvious symptoms, apply 3%-5% acetic acid to the suspected lesion for 5-10 minutes (15 minutes for perianal lesions), and you can see that part of the skin and mucous membranes turn white, that is, the acetic acid white test is positive, which can be regarded as condyloma acuminatum One of the basis of the diagnosis. Reprint please indicate: Nanjing Institute of gifted Ka medical wart virus Lixing Chun, otherwise declined to reprint.

Can condyloma acuminata relapse many years after being cured?

If condyloma acuminata does not occur for many years after treatment, whether it will happen next is a question of concern to everyone. First of all, everyone does not need to worry. Generally, the recurrence rate of condyloma acuminata is the highest thing after three months of treatment. If there is no seizure after one year, then there will be no recurrence, even if it is a relapse, it is not a recurrence. It is very likely that the patient is infected again, so you must pay special attention to it after treatment.  Analysis of the cause of recurrence of condyloma acuminatum   1. Damage or virus incomplete elimination, residual lesions or potential HPV infection are the main reasons for the recurrence of senile condyloma acuminatum. After the warts are removed, 45% of patients still have latent infection, that is, HPV is not completely cleared, and 67% have recurrence. Latent viral infection may exist in the skin around the lesion, such as around and deep within the lesion, hair follicles, or other lymph nodes and nerve nodes in the body. 2. Condyloma acuminatum inoculation infection    laser and surgical resection may contaminate other parts of the lesion with HPV, such as inoculation of the skin and mucous membranes around and distal to the lesion.  3. Indirect transmission of hpv-contaminated items may also be a recurrence factor. Contact with towels, underwear, etc. contaminated by HPV again.   It is recommended that everyone choose the traditional treatment in my country at the beginning of the disease, and use Chinese medicine to “remove warts and clear toxins, treat both symptoms and root causes”, and treat them step by step to avoid repeated attacks. Generally, non-serious conditions are completely cured by the Chinese medicine prescription No. 2011101665723. For severe cases, the treatment time should be estimated by the doctor after face-to-face consultation.

What are breast nodules? What is the grade of breast nodules?

   Breast nodule usually refers to a disease in which a lumps are generated inside the breast tissue due to changes in the structure of the breast tissue. It is a morphological change of breast tissue, which is more common in breast diseases such as breast hyperplasia, breast benign tumors, and breast malignant tumors.   Breast hyperplasia: It is common in women between 30 and 50 years old. It is a disorder of the normal structure of the breast caused by periodic changes in hormones. If it is not accompanied by atypical hyperplasia, treatment is generally not required.   Benign tumors: such as breast fibroadenoma, lipoma, etc., which are mostly caused by hormonal disorders in the body. The probability of malignant transformation is very low. If there is no change in symptoms, regular inspections are enough.   Malignant tumors: such as breast cancer, breast lymphoma, etc. It must be detected and treated early!   When you see breast cancer, you may be nervous, but you don’t need to be too anxious. Most diseases that cause breast nodules are benign, and the probability of malignant tumors is very small. Moreover, the current treatment options related to breast tumors are also very mature, and most of the prognosis is relatively good.   After detecting breast nodules with ultrasound or mammography, the doctor will use the “Breast Imaging Report and Data System (BI-RADS)” to classify the nodules based on their imaging findings. The BI-RADS classification method divides breast lesions into grades 0 to 6, which are used to assess the degree of benign and malignant breast lesions. Generally speaking, the higher the level, the greater the possibility of malignancy.   Level 0: Indicates that the inspection effect is not satisfactory and needs to be redone, or needs to be evaluated in conjunction with other inspections.   Level 1: Indicates that there is no abnormality.   Level 2: Generally speaking, nodules or lesions are benign and need to be reviewed regularly, generally once a year.   Grade 3: It means that the lesion may be benign, but the interval of review is shorter than that of Grade 2, usually every 3 to 6 months.   Level 4: It means that the possibility of malignant lesions is relatively high, and surgery or biopsy is needed to clarify the benign and malignant lesions for the next step. At the same time, the level 4 is also divided into 4A, 4B, and 4C, indicating that the malignancy may be getting higher and higher.   Grade 5: Malignant lesions are highly suspected, or the doctor who performed the imaging examination can almost be sure that it is malignant. It is necessary to perform surgery to remove the lesion, perform a biopsy, and determine the next treatment plan.   Grade 6: It means that a biopsy has been done and the pathologist has determined that it is a malignant lesion.   So when everyone sees the word nodule on the inspection report, don’t panic, and don’t arbitrarily diagnose whether it is benign or malignant. Do the examination according to the doctor’s recommendation, and then take further treatment measures.

Is female genital warts difficult to treat?

Condyloma acuminatum symptom disease is a kind of sexually transmitted disease, which is a disease that both women and men suffer from. The main reason for the symptomatic disease is due to unclean sex. Therefore, many patients feel shy when they sound like this disease. Suffering from this disease is very ashamed, so do not go for treatment, this will delay the disease.   Condyloma acuminatum is not a terminal illness, it can be cured, but if a female patient gets it, the treatment is much more difficult. This is because the female reproductive system is more complicated than that of men, and it is precisely because of this particularity that women are very susceptible to this disease. Condyloma acuminatum is generally transmitted through unclean sexual contact. When a man with the virus gets close to a woman, the virus grows quietly. At present, the topical therapies for the treatment of condyloma acuminatum include laser therapy, drug therapy, cryotherapy, microwave therapy, and surgical therapy. The reasonable choice of these therapies depends on the patient’s physical condition and pathology, especially the pathology, such as the occurrence of lesions. The location and the extent, type and size of the lesion. However, according to clinical data, the recurrence rate of these physical topical therapies is very high, and some may even become more and more serious.   It is recommended that everyone choose the traditional treatment in my country at the beginning of the disease, and use Chinese medicine to “remove warts and clear toxins, treat both symptoms and root causes”, and treat them step by step to avoid repeated attacks. Generally, non-serious conditions are completely cured by the Chinese medicine prescription No. 2011101665723. For severe cases, the treatment time should be estimated by the doctor after face-to-face consultation.

X-ray, CT and MRI examinations cannot replace each other

&nbsp.&nbsp.&nbsp.&nbsp.&nbsp.&nbsp. Often patients in outpatient clinics often require CT to replace ordinary X-ray examinations or require magnetic resonance (MRI) to replace CT examinations due to inconvenience or difficulty. Magnetic resonance (MRI) imaging is clearer than CT, and CT is clearer than X-ray examination. To replace the X-ray and CT with MRI results, only one examination is required. This view is incorrect, and the three inspection methods are not interchangeable.   First choice for X-ray disease screening X-ray examination is inexpensive and suitable for routine examination of most patients, especially the preferred screening method for disease screening. It has good diagnostic value for fracture displacement, bone disease with bone changes, bone lesions in joints, opaque foreign body retention, cardiopulmonary organic diseases, digestive system obstruction and other diseases.   In addition, the X-ray film can detect diseases where the patient only feels discomfort when changing the posture. Especially for power bit film inspection, it is very rare in China that magnetic resonance can replace X-ray inspection.  CT can show that the CT examination of vascular lesions is obviously better than X-rays in displaying the cross-section, especially for the high-density tissue clear, and the accuracy of measuring the distance between bone structures is high. CT can clearly show the direction of blood vessels and vascular lesions, and the sensitivity of tumor detection is significantly higher than that of ordinary X-ray films. Moreover, multi-row spiral CT can perform three-dimensional imaging, which is helpful to display tissue and organ lesions in three dimensions. However, CT scans are limited to technicians with different professional levels and scan interval intervals, and cannot read the information of the inspection site as a whole, resulting in a certain rate of missed diagnosis. In addition, CT’s visualization and resolution of soft tissues are not high.   MRI is better for soft tissues. The biggest difference between MRI and X-ray and CT examinations is that there is no X-ray radiation during the examination, and the damage to the body is very small. Mainly used to find soft tissue diseases, orthopedics is mainly used to find intervertebral disc disease, spinal cord disease, meniscus disease, inflammatory disease and hemorrhagic disease. Through different treatment techniques, cancellous bone fractures such as vertebral fractures and pelvic fractures can be detected early; inflammatory diseases such as aseptic necrosis of the femoral head, tuberculosis, and bone tumors can be detected early. MRI is highly sensitive to vascular diseases. However, MRI also has disadvantages: first, the cost of ordinary MRI examination is relatively expensive; second, the examination time of each part is longer; third, the imaging accuracy of some bone tissue is not as good as CT; and the cost of dynamic MRI is dynamic X-ray film The number is 10 times. Therefore, in the diagnosis, X-ray examination is preferred for spine fractures, spondylolisthesis, spine deformity, spinal instability and other diseases; degreasing phase MRI examination can be used to determine whether it is a fresh fracture; when diagnosing disc disease, especially cervical spondylosis, it is preferred MRI examination is also the first choice for the examination of spinal morphology, spinal cord deformity, spinal tumors, spinal tuberculosis and other diseases. CT examination has an irreplaceable advantage in the diagnosis of spinal fractures, spinal canal diseases, and articular process joint diseases. In short, the three are irreplaceable. It is not that the more expensive the test, the more problems can be found. When you go to the doctor, you must follow the doctor’s test requirements so that you can find the problem as early and accurately as possible.

What causes genital warts in the urethra

  Condyloma acuminatum refers to the growth of warts of genital warts in the urethra. The clinically common depth is 1-1.5cm from the urethral opening, and it is difficult to develop lesions deep in the urethra. The symptoms of urethral condyloma acuminatum show frequent urination, urgency, dysuria, and changes in urine flow curve.  If the urethral lesions seriously affect the bladder, bilateral ureteral obstruction may occur, causing hydronephrosis, kidney infection, and renal insufficiency. Damage to the pelvis can cause intestinal obstruction, lower extremity edema. When the damage occurs in the anus and rectum, there may be swelling in the anus, blood in the stool, poor bowel movements, or pain during bowel movements.  How is urethral condyloma caused? 1. Sexual contact infection: Infection of pathogens through sexual contact; 2. Non-sexual direct infection: infection through contact with lesions and patient secretions; 3. Indirect contact: infection through patient’s clothing and supplies; 4. Source infection : Contact infection during treatment such as examination, surgery, and medication.

Uterine cyst (cystic adenomyosis)

Uterine cysts&nbsp.&nbsp. Uterine cysts are actually not so common in clinic. The muscular layer of the uterus is muscle tissue. Unlike the ovary, there are many cystic structures in the ovary. Follicles, corpus luteum, and tumors may all be cysts. Sexually, a cyst is formed, and a cyst in the uterus often indicates some degenerative diseases of the myometrium. &nbsp.&nbsp. Uterine cysts are most commonly caused by the liquefaction of uterine fibroids. A fibrous cavity may be formed inside the fibroids. Ultrasound will appear as an echoless cyst. Another more common one is cystic adenomyosis, because the endometrium erodes into the myometrium, forming a localized bleeding focus. In general, the bleeding focus of adenomyosis is not too large, so there will be no cyst formation. , But in some cases a large cyst may also form. &nbsp.&nbsp. The following case is a cystic adenomyosis patient we dealt with in 2019. The patient is from Shandong, 27 years old, has a history of birth, has had severe dysmenorrhea in the past 7 years, before coming to the clinic It was found that a cyst was treated on the uterus, 3.4*2.9*3.3cm, combined with the medical history, we considered the existence of cystic adenomyosis. In the subsequent MRI examination, it was confirmed that there was a bleeding lesion in the uterine wall (see figure below). &nbsp.&nbsp.Figure 1. Ultrasound suggests cystic nodules in the corner of the uterus&nbsp.&nbsp.Figure 2. MRI sagittal position shows bleeding lesions on the uterine wall (white part in the figure)&nbsp.&nbsp.Figure 3.MRI cross section The uterine lesions can be seen on the surface. The traditional treatment for cystic adenomyosis is to use laparoscopic uterine lesion resection or hysterectomy. This method is relatively more invasive. After the outpatient ultrasound evaluation path, we The ultrasound subvaginal microwave ablation method used for her is based on the method of puncturing the lesion with a microwave ablation needle and releasing the heat energy to destroy the lesion. &nbsp.&nbsp.Figure 4. The process of microwave ablation treatment&nbsp.&nbsp. This puncture ablation treatment is equivalent to a shot in the uterus. The trauma is much smaller than laparoscopic surgery. &nbsp.&nbsp.Figure 5. Postoperative MRI (sagittal position)&nbsp.&nbsp.Figure 6 Postoperative MRI (coronary position)&nbsp.&nbsp.From the postoperative pictures of Figures 5 and 6, the cystic adenomyosis lesions It was destroyed by energy. The black shadow on the picture shows that there is no blood supply, which is in sharp contrast with the surrounding uterine wall. &nbsp.&nbsp. After the operation, the patient’s dysmenorrhea symptoms have been eliminated and continue to this day. &nbsp.&nbsp. As can be seen from this example, cystic adenomyosis is also a type of uterine cyst. Generally, liquefied uterine fibroids do not require surgical treatment, but we also have innovative treatments for symptomatic uterine cysts (cystic adenomyosis). Program. &nbsp.&nbsp. I hope this article is helpful to everyone. Gong Xiaoming, MD, chief expert of the Micro-invasive Center for Uterine Fibroids; former Deputy Chief Physician, Associate Professor of Obstetrics and Gynecology, Peking Union Medical College Hospital; former Deputy Director of Gynecology, Shanghai First Maternal and Child Health Hospital;