激光光凝后曲张大隐静脉的组织病理学变化

目的探讨激光光凝后曲张大隐静脉的组织病理学变化。方法采用810nm波长激光器,功率为12W,暴光时间1s,血管内光凝治疗曲张大隐静脉9例,光凝后3h取血管行组织病理学检查,观察光凝后血管结构变化。以正常静脉和治疗前曲张静脉作为对照。结果正常静脉分3层,内膜为单层血管内皮细胞,中膜为平滑肌细胞、弹力纤维和胶原纤维等,外膜为一疏松排列的结缔组织。曲张静脉组织学检查见内膜不完整,内皮细胞之间连接疏松,中膜平滑肌细胞增生、肥厚或萎缩,弹力纤维减少,胶原纤维增多。光凝后管腔内可见大量血细胞,血小板扁平,伸出伪足,贴附于胶原表面;血管内皮细胞和靠近管腔部位的平滑肌细胞结构破坏,细胞浆外溢,和细胞外基质融合;靠近血管腔部位的弹力纤维和胶原纤维断裂,部分脱落于管腔;靠近外膜部位的弹力纤维和胶原纤维和外膜结构没有改变。结论激光光凝治疗曲张静脉的内膜和部分中膜结构破坏,大量血细胞聚集于管腔,促进血小板附着于血管壁。     

The Clinical Practice of Interventional Radiology: A European Perspective

The purpose of this study was to determine the current clinical environment in which interventional radiology (IR) is practiced throughout Europe. A survey, comprising 12 questions on IR clinical practice, was sent to 1800 CIRSE members. Members were asked to return one survey per department. Two hundred seventy-four departments returned completed questionnaires, 22% from the United Kingdom (n = 60), 11% from Germany (n = 30), 8% from Austria (n = 23), and the remainder spread over Europe. Experts, with more than 10 years of IR experience, comprised 74% of the survey group. Almost one-third of the radiologists dedicated more than 80% of their clinical sessions to IR alone (27%; n = 75), with two-thirds practicing in a university teaching hospital setting (66%; n = 179). Few institutions have dedicated IR inpatient hospital beds (17%; n = 46), however, to compensate, day case beds are available (31%), IR admitting rights are in place (64% overall, 86% for in-patients, and 89% for day cases), and elective IR admissions can be made through other clinicians (87%). IR outpatient clinics are run at 26% of departments, with an average of two sessions per week. Dedicated nurses staff the majority of IR suites (82%), but clinical junior doctors are lacking (46%). Hospital management’s refusing access to beds was the most commonly cited reason for not developing a clinical IR service (41%). In conclusion, there is marked variation across European centers in the current practice of IR. Half do not have dedicated junior doctors and only a small minority have inpatient hospital beds. If IR is to be maintained as a dedicated clinical specialty, these issues need to be addressed urgently.     

经大隐静脉插管栓塞术治疗下肢静脉曲张的临床价值

目的评价X线监视下经导管注入无水乙醇治疗下肢静脉曲张的远期疗效及安全性。资料与方法对69例(78条患肢)下肢静脉曲张患者行穿刺或切开内踝上方大隐静脉插入导管,在X线及对比剂监视下注入无水乙醇栓塞治疗。结果 75条(96.%)患肢均一次性栓塞成功;75条患肢于术后7天～3个月多普勒超声显示栓塞的大隐静脉未探及血流信号。随访3～55个月(平均31.2个月),术后3～7天曲张的静脉均塌陷,2～3周临床症状明显减轻或消失,7条小腿溃疡于术后4～6周愈合。13例(18.8%)术后出现咳嗽、胸闷,5～10 min内消失;7条患肢(9.0%)术后肢体出现迟发性感觉异常,2～3周内恢复正常;31条(39.7%)患肢术后第2天出现轻度肿胀,1～2周内均消失;3条(3.8%)患肢于术后12个月内出现小腿浅静脉局限性轻度曲张,无1例深静脉血栓等严重并发症发生。结论经大隐静脉插管注入无水乙醇治疗下肢静脉曲张安全、并发症少,远期疗效肯定;有望成为下肢静脉曲张新的治疗方法之一。     

Fluoroscopy-Guided Endovenous Sclerotherapy Using a Microcatheter Prior to Endovenous Laser Ablation: Comparison between Liquid and Foam Sclerotherapy for Varicose Tributaries

Objective

To compare the efficacy and adverse effects of endovenous foam sclerotherapy (EFS) and liquid sclerotherapy (ELS) using a microcatheter for the treatment of varicose tributaries.

Materials and Methods

From December 2007 to January 2009, patients with venous reflux in the saphenous vein were enrolled. The foam or liquid sclerosant was injected through a microcatheter just before endovenous laser ablation (EVLA). Patients were evaluated for the technical success, clinical success, and procedure-related complications during the procedure and follow-up visits.

Results

A total of 94 limbs were included: 48 limbs (great saphenous vein [GSV], 35; small saphenous vein [SSV], 13) were managed using EFS and EVLA (foam group; FG), and 46 limbs (GSV, 37; SSV, 9) were treated by ELS and EVLA (liquid group; LG). Varicose tributaries demonstrated complete sclerosis in 92.7% with FG and in 71.8% with LG (p = 0.014). Bruising (78.7% in FG vs. 73.2% in LG, p > 0.05), pain or tenderness (75.6% in FG vs. 51.2% in LG, p = 0.0237) were noted. Hyperpigmentation (51.2% in FG vs. 46.2% in LG, p > 0.05) was found.

Conclusion

Endovenous foam sclerotherapy using a microcatheter is more effective than ELS for eliminating remnant varicose tributaries prior to EVLA. However, EFS is more commonly associated with local complications such as pain or tenderness than ELS. Furthermore, both techniques seem to prolong the duration of hyperpigmentation along with higher costs.     

髂静脉受压综合征腔内治疗的初步报告

目的评价腔内介入治疗(超声消融术、血管成形术及支架置入术)在治疗髂静脉受压综合征(IVCS)中的临床效果。方法经下肢深静脉造影确诊12例IVCS患者,经健侧股静脉穿刺置入下腔静脉滤器(8例)后,通过患肢股静脉小切口行超声消融术、腔内血管成形术及支架置入术治疗。结果12例IVCS患者髂静脉再通均获成功,无严重并发症发生。术后临床治愈8例,有效3例,无效1例。随访12~47月,1例术后8月管腔再闭(支架内血栓形成)。结论多项介入技术综合治疗IVCS是一种创伤小、安全有效的方法。     

Marketing a Radiology Practice

In addition to being a profession, the practice of radiology is a business, and marketing is an important part of that business. There are many facets to marketing a radiology practice. The authors present a number of ideas on how to go about doing this. Some marketing methods can be directed to both patients and referring physicians. Others should be directed just to patients, while still others should be directed just to referring physicians. Aside from marketing, many of them provide value to both target audiences.     

湿润烧伤膏联合大隐静脉腔内激光治疗下肢静脉曲张性溃疡疗效观察

目的观察湿润烧伤膏联合大隐静脉腔内激光治疗下肢静脉曲张性溃疡的临床疗效。方法选取2016年5月至2018年6月广西壮族自治区江滨医院普外科收治的60例下肢静脉曲张性溃疡患者作为研究对象,并按照随机数表法将其随机分为观察组(30例)与对照组(30例),其中观察组患者于大隐静脉腔内激光术后采用湿润烧伤膏治疗溃疡创面,对照组患者于大隐静脉腔内激光术后采用碘伏消毒治疗溃疡创面,对比观察两组患者治疗第7天时的创面肉芽组织生长率及住院时间。结果观察组患者治疗第7天时的肉芽组织生长率为(0.425±0.084)%、住院时间为(12.30±3. 42) d,对照组患者治疗第7天时的肉芽组织生长率为(0.368±0.106)%、住院时间为(15. 94±5.46) d,两组患者肉芽组织生长率及住院时间对比,P均0.05,差异具有统计学意义。结论湿润烧伤膏联合大隐静脉腔内激光治疗下肢静脉曲张性溃疡,可明显促进创面肉芽组织生长,缩短住院时间,疗效显著,值得临床推广应用。     

下肢浅静脉曲张激光治疗术后复发的临床分析

目的 探讨腔内激光治疗下肢浅静脉曲张术后复发的原因及防治方法.方法 回顾性分析353例(415条肢体)下肢静脉曲张患者的临床资料.结果 38例(40条肢体)患者术后复发,复发率为9.64%.复发原因分别为:18条肢体交通支功能不全,14条肢体大隐静脉主干再通,5条肢体小隐静脉主干未处理,2条肢体深静脉瓣膜功能不全,1条肢体双大隐静脉畸形.38例患者均经再次手术,分别随访1～4年无复发.结论 根据静脉曲张程度和病因采取针对性手术,重视过度扩张大隐静脉的高位结扎和交通支血管的处理是预防术后复发的关键.     

下肢静脉曲张性溃疡的临床治疗

目的:总结治疗下肢静脉曲张并发慢性溃疡的有效治疗方法.方法:自2002年3月至2007年3月,对35例下肢静脉曲张并发难治性小腿溃疡患者先采取曲张静脉手术治疗,而后采用湿润烧伤膏换药治疗(治疗组);23例曲张静脉不做手术处理,直接采用传统的生肌散外敷治疗(对照组).结果:治疗组溃疡创面全部治愈,平均愈合时间18d±9.3d,复发1例;对照组平均愈合时间28d±9.6d,复发8例,治疗组疗效明显优于对照组,P＜0.01.结论:MEBO联合曲张静脉手术疗法,治疗难治性下肢静脉曲张性慢性溃疡的疗效优于单纯生肌散疗法.     

Current State of Private Practice and Academic Interventional Radiology: Differences in Practice Structure,Case Mix,and Productivity

PurposeTo investigate whether private practice interventional radiology (IR) groups self-report higher overall productivity given differing case mix and more diagnostic radiology interpretation.Materials and MethodsA 60-question survey was distributed to 3,159 self-identified US IR physicians via the Society of Interventional Radiologists member search engine, with 357 responses (11.3% response rate). Of these responses, there were 258 unique practices from 34 US states.ResultsOut of 84 IR group responses, private practice IR (PPIR) physicians reported a minimal trend for higher annual work relative value units (wRVUs) per clinical full-time equivalent compared with academic IR physicians (8,000 versus 7,140, P = .202), but this did not reach statistical significance. PPIR groups reported fewer median weekly hours (50 versus 52), more frequent call (every 6 versus every 5 days), and significantly higher median tenured compensation ($573,000 versus $451,000, P = .000). Out of 179 responses, academic practices reported significantly higher case percentages of interventional oncology and complex hepatobiliary intervention (P <.001), and private practices reported significantly higher percentages of musculoskeletal intervention (P < .001) with a nonsignificant trend for stroke or neurologic intervention (P = .010). Private practices reported more wRVUs from the interpretation of diagnostic imaging, at 26% of total wRVU production compared with 7% of total wRVU production for academic practices (P < .001; n = 131).ConclusionsSelf-reported data from private and academic IR groups suggest minimally higher wRVUs per clinical full-time equivalent among PPIRs with lower weekly work hours, more frequent call, differing case mix, and significantly higher tenured compensation among PPIR groups.     

Forecasting the Effect of the Change in Timing of the ABR Diagnostic Radiology Examinations: Results of the ACR Survey of Practice Leaders

The results of a survey sent to practice leaders in the ACR Practice of Radiology Environment Database show that the majority of responding groups will continue to hire recently trained residents and fellows even though they have been unable to take the final ABR diagnostic radiology certifying examination. However, a significant minority of private practice groups will not hire these individuals. The majority of private practices expect the timing change for the ABR certifying examinations to affect their groups’ function. In contrast, the majority of academic medical school practices expect little or no impact. Residents and fellows should not expect work time off or protected time to study for the certifying examination or for their maintenance of certification examinations in the future.     

Radiology in Medical Education: A Pediatric Radiology Elective as a Template for Other Radiology Courses

PurposeTraditionally, the pediatric radiology elective for medical students and pediatric residents constituted a morning teaching session focused mainly on radiography and fluoroscopy. A more structured elective was desired to broaden the exposure to more imaging modalities, create a more uniform educational experience, and include assessment tools.MethodsIn 2012, an introductory e-mail and formal syllabus, including required reading assignments, were sent to participants before the start date. A rotating weekly schedule was expanded to include cross-sectional imaging (ultrasound, CT, MR) and nuclear medicine. The schedule could accommodate specific goals of the pediatric resident or medical student, as requested. Starting in 2013, an online pre-test and post-test were developed, as well as an online end-of-rotation survey specific to the pediatric radiology elective. Taking the Image Gently pledge was required. A scavenger hunt tool, cue cards, and electronic modules were added.ResultsPre-test and post-test scores, averaged over 2 years, showed improvement in radiology knowledge, with scores increasing by 27% for medical students and 21% for pediatric residents. Surveys at the end of the elective were overwhelmingly positive, with constructive criticism and complimentary comments.ConclusionsWe have successfully created an elective experience in radiology that dedicates time to education while preserving the workflow of radiologists. We have developed tools to provide a customized experience with many self-directed learning opportunities. Our tools and techniques are easily translatable to a general or adult radiology elective.     

Emergency Radiology: Current Challenges and Preparing for Continued Growth

The escalation of imaging volumes in the emergency department and intensifying demands for rapid radiology results have increased the demand for emergency radiology. The provision of emergency radiology is essential for nearly all radiology practices, from the smallest to the largest. As our radiology specialty responds to the challenge posed by the triple threat of providing 24-7 coverage, high imaging volumes, and rapid turnaround time, various questions regarding emergency radiology have emerged, including its definition and scope, unique operational demands, quality and safety concerns, impact on physician well-being, and future directions. This article reviews the current challenges confronting the subspecialty of emergency radiology and offers insights into preparing for continued growth.     

Budd-Chiari综合征:肝静脉病变的多排螺旋CT诊断

目的探讨多排螺旋CT(MSCT)对Budd-Chiari综合征(BCS)肝静脉阻塞病变的诊断价值。方法对比分析26例BCS的肝静脉血管造影和术前1周内的MSCT平扫与增强扫描表现。结果26例MSCT横断面图像和重建图像显示肝静脉共计70条,其中56条肝静脉闭塞,包括13条肝右静脉闭塞,21条肝中静脉闭塞,22条肝左静脉闭塞;另显示21条副肝静脉代偿性增粗;其中1例肝右静脉伴有血栓形成。与下腔静脉或经皮肝穿刺肝静脉造影相比,肝静脉的符合率为92.11%。结论MSCT能准确显示BCS肝静脉的血流动力学变化、阻塞部位,性质以及肝内交通支情况,诊断价值高,能可靠的指导制订治疗方案。