Quality assessment and assurance in diagnostic imaging. Theoretical and practical considerations and a quality audit of the excretory urogram

Concepts necessary to an understanding of the basics of quality assurance audits are presented. Included are specific examples that bridged theory and practice by applying the protocol to a real-life diagnostic imaging situation. This method meets the present requirements of the Joint Commission of the Accrediation of Hospitals.     

Colon perforation following percutaneous nephrostomy and renal calculus removal

Two patients had colonic perforation as a result of percutaneous nephrostomy placement followed by track dilatation and renal calculus removal. We present the technical aspects of nephrostomy placement and stone removal, as well as the clinical diagnosis and management of these cases. Both patients recovered well with conservative therapy and required no surgical intervention. This report reviews the anatomic considerations for percutaneous nephrostomy in patients undergoing renal stone removal.     

肾康片质量标准的研究

目的：研究肾康片的质量标准并控制该制剂的质量。方法：用薄层色谱法鉴别了肾康片中的黄芪,山茱萸,桑寄生及丹参,用薄层色谱法限量检查屯该制剂中的乌头碱,用双波长薄层扫描法测定了该制剂中黄芪甲苷的含量。结果：乌头碱限量符合中国药典测定,黄芪甲苷的平均回收率为９７．５％,其ＲＳＤ为１．４３％。结论：本文的结果显示出这些方法可用于控制该制剂的质量,方法灵敏,简便,专属,准确。     

Cervical myelography: survey of modes of practice and major complications

A total of 68 major complications of cervical myelography were reported by 220 neuroradiologists in a mail survey. Two-thirds of the complications were attributed to cervical spine hyperextension and one-third to lateral C1-2 puncture. Narrow sagittal diameter of the spinal canal and severe cervical spondylosis were frequent contributing factors to hyperextension injury of the cervical spinal cord. Clinical and radiographic premyelography screening is suggested, with magnetic resonance imaging performed first in patients with spinal canal stenosis, severe spondylosis, and/or myelopathy of any cause. Neck extension should be minimal during myelography. All C1-2 punctures should be monitored with lateral fluoroscopy for accurate needle positioning and prevention of contrast medium injection into the spinal cord.     

Primary retroperitoneal myxoid/round cell liposarcoma is a nonexisting disease: an immunohistochemical and molecular biological analysis

Almost all primary retroperitoneal liposarcomas can be classified as well-/dedifferentiated liposarcoma. Rarely, however, primary retroperitoneal liposarcoma is classified as myxoid/round cell liposarcoma, based on the presence of myxoid areas and vascular crow's feet pattern, which has resulted in a debate on the classification of liposarcoma in the retroperitoneum. Genetically, myxoid/round cell liposarcoma and well-/dedifferentiated liposarcoma are different diseases. Myxoid/round cell liposarcoma is characterized by a translocation causing FUS-CHOP or EWSR1-CHOP fusion, whereas well-/dedifferentiated liposarcoma is characterized by an amplification of the 12q13-15 region, including MDM2 and CDK4 genes. As myxoid/round cell liposarcoma is highly radio- and chemosensitive, differentiation between subtypes is important to optimize treatment. We studied whether primary retroperitoneal liposarcomas diagnosed as myxoid/round cell liposarcoma represent molecularly true myxoid/round cell liposarcoma or are histopathological mimics and represent well-/dedifferentiated liposarcoma. Primary retroperitoneal myxoid/round cell liposarcoma (n=16) were compared to primary extremity myxoid/round cell liposarcoma (n=20). Histopathological and immunohistochemical features were studied. Amplification status of the 12q13-15 region was studied using a multiplex ligation-dependent probe amplification analysis, and FUS-CHOP or EWS-CHOP translocations were studied using RT-PCR. In primary retroperitoneal myxoid/round cell liposarcoma, MDM2 and CDK4 staining was both positive in 12 of 15 cases. In primary extremity myxoid/round cell liposarcoma, MDM2 was negative in 18/20 and CDK4 was negative in all cases. Multiplex ligation-dependent probe amplification showed the amplification of 12q13-15 region in 16/16 primary retroperitoneal myxoid/round cell liposarcomas and in 1/20 primary extremity myxoid/round cell liposarcomas. Translocation was present in all (18/18) primary extremity myxoid/round cell liposarcomas, but absent in all primary retroperitoneal myxoid/round cell liposarcomas. On the basis of immunohistochemical and molecular characteristics, apparent primary retroperitoneal myxoid/round cell liposarcoma can be recognized as well-/dedifferentiated liposarcoma with morphological features mimicking myxoid/round cell liposarcoma. In these cases, treatment should probably be specifically designed as for well-/dedifferentiated liposarcoma. Moreover, finding of myxoid/round cell liposarcoma translocations in a retroperitoneal localization is highly suggestive of metastasis and should prompt search for a primary localization outside the retroperitoneum.     

醋酸锌对谷氨酸诱导的小鼠脑片即早基因过度表达的抑制作用

目的：探讨谷氨酸对脑组织即早基因表达的影响以及醋酸锌对谷氨酸诱导c-fos和c-jun过度表达的拮抗作用。方法：体外小鼠海马脑片培养；在培养基中加入200μmol/L的谷氨酸（或同时加入谷氨酸和醋酸锌），作用0.5,1,2,3h，然后进行RT-PCR实验，检测c-fos和c-jun的表达变化。结果：200μmol/L谷氨酸处理的脑片中，1-2h期间c-fos的表达升高，当谷氨酸与100μmol/L醋酸锌共同处理脑片时，1-3h期间c-fos表达基本恢复正常；200μmol/L谷氨酸作用下，脑片c-jun表达水平从0.5h起即明显升高，谷氨酸与醋酸锌共同作用时，可见c-jun基因在各检测时段表达基本接近正常。结论：谷氨酸可引起c-fos及c-jun的过度表达，锌离子可拮抗谷氨酸诱导的c-fos和c-jun过度表达作用，使二基因表达恢复正常。