Feasibility and efficacy of placement of continuous sciatic perineural catheters solely under ultrasound guidance in children: a descriptive study

Background: Placement of sciatic catheters with ultrasound and stimulating catheters is known. Literature regarding catheter placements with only ultrasound is limited. We aimed to investigate the feasibility of performing continuous sciatic nerve block exclusively with ultrasound guidance and minimal equipment. Method: Forty ASA 1 and 2 patients aged 8 months–10 years posted for congenital talipoequinovarus surgery were included in the study. Continuous sciatic catheters were placed under ultrasound guidance with 18‐ gauge Tuohy needle at the infragluteal fold. Then, 0.25% of bupivacaine 0.5 ml·kg^?1 bolus was injected followed by continuous infusion later. Half the volume of the drug was injected prior to catheter insertion to improve visibility. The sciatic nerve, needle tip and shaft, catheter tip and the drug spread were visualized. The efficacy of the block intraoperatively and postoperatively was evaluated. Results: The sciatic nerve, needle shaft, and tip were well visualized in all 40 patients. The catheter tip was seen in 72.5% of patients. The effect of block was complete intraoperatively and postoperatively. Clinically significant complications were absent. Conclusion: We conclude that in children, continuous sciatic catheters can be accurately and efficaciously placed with minimal equipment with ultrasound alone.     

Intraductal papillomas of the breast: diagnosis and management of 151 patients

Introduction

The assessment of papillary lesions continues to be a challenging area in breast radiology and pathology. The management of intraductal papillomas without atypia of the breast remains controversial. The purpose of the present study was to determine diagnostic accuracy of radiographical diagnosis, core biopsy, and surgical excision in papillary breast lesions.

Material and methods

By using files from 1995 to 2010, 151 cases of intraductal papilloma with or without atypia were identified. Patients were stratified as follows: core biopsy followed by surgical excision (n = 61), core biopsy alone (n = 19), and surgical excision alone (n = 71).

Results

The upstage rate of intraductal papillomas without atypia on core biopsy to atypia or malignancy on excision was 8.9%. Excision specimens revealed intraductal papillomas without atypia in 68 out of 71 cases, and atypical papillomas in 3 cases.

Conclusion

Our findings suggest that radiographic and histopathological diagnosis of intraductal papillomas show high accuracy and good concordance. In cases where the radiographic diagnosis reveals suspicious lesions core biopsy represents the first choice.     

直径＜3cm肺部结节的CT引导经皮穿刺活检

目的：评价肺小结节ＣＴ导引经皮穿刺术的准确性、并发症及应用价值。材料与方法：选择１９９１年８月至１９９８年５月的１９０例经皮肺穿刺术患者中肺部结节直径〈３．０ｃｍ并经病理或随访证实的５０例（５０个结节）,共做了５８次穿刺,均做细胞学和组织学检查。病灶直径最小０．５ｃｍ（平均２．４ｃｍ）。结果：５０例中恶性肿瘤３４例（原发性支气管肺癌２７例,转移癌７例）,穿刺确诊３０例,２３例穿刺与手术病理一致,７     

预防性抗生素在经直肠前列腺穿刺活检术中的应用

目的 评价和探讨抗生素防治前列腺穿刺活检术后感染的有效方法。方法 对192例前列腺疾病患者行经直肠超声引导13点前列腺系统穿刺活检术。所有患者随机分为3组。A组62例,口服安慰剂（维生素C）;B组64例,口服单剂量环丙沙星0．5g加甲硝唑0．4g/d;C组66例,分2次口服环丙沙星1.0g加甲硝唑0.8g/d,共3d;所有患者均在活检后48h进行尿培养,发热者再进行血培养。结果 3组患者感染性并发症（尿路感染和发热）的发生率为A组11％（7／62）,B组3％（2／64）,C组3％（2／66）,C组3％（2／66）。感染性并发症的发生率在A组明显高于B组（χ^2=7.16)和C组（χ^2=7.34),差异具有显著性意义（P＜0．01）。而B、C两组间感染性并发症的发生率相当（χ^2=0.23),差异无显著性意义（P＞0．05）。结论 应用恰当的单剂量抗生素预防经直肠前列腺穿刺活检术后的感染是有效的。     

硬膜外穿刺针外套管在腹腔镜小儿斜疝高位结扎术中的应用

目的探讨硬膜外穿刺针外套管在腹腔镜小儿斜疝疝囊高位结扎中的应用价值。方法2003年4月-2006年5月,我院对230例小儿斜疝手术应用硬膜外穿刺针外套管代替雪橇钩针实施腹腔镜疝内环口荷包高位结扎术。结果230例手术均获得成功,手术时间：单侧161例8-10 min,嵌顿疝39例15-20 min,双侧30例16-20 min;术后未见有阴囊水肿及睾血疼痛及缺血坏死。术后随访2-6个月111例,6-12个月52例,12-24个月37例,24-36个月30例,无复发。结论硬膜外刺针外套管可替代小儿疝囊结扎专用的雪橇钩针,简便,经济,适合在所有基层医院推广。     

小针刀辅助自体脂肪颗粒移植在面部除皱及凹陷充填中的应用

目的探讨小针刀辅助自体脂肪颗粒注射除去额部、眉间、鼻唇沟等部位皱纹及充填面部凹陷的效果。方法利用自制小针刀,离断真皮与其下方的"纤维粘连",然后用自体脂肪颗粒注射除皱和充填凹陷部位。结果本组共68例。修复面积最大约10cm×8cm,最小约1.5cm×0.5cm。随访45例,随访时间3～18个月,效果满意或基本满意。结论小针刀辅助自体脂肪移植具有操作简单、快捷、价廉、安全、无排异、不留瘢痕、术后恢复快等优点,患者易于接受,是除去额部、眉间、鼻唇沟等部位皱纹及填充面部凹陷的有效方法。     

Endoscopic transmural entry into pancreatic fluid collections using a dedicated aspiration needle without endoscopic ultrasound guidance: success and complication rates

BACKGROUND: Endoscopic drainage of pancreatic fluid collections (PFC) is performed with increasing frequency. A variety of techniques for performing transmural entry have been described. However, data are lacking on the technical success and safety of transmural entry using a single technique. The authors describe the largest experience in transmural entry of PFCs without endoscopic ultrasound (EUS) guidance using a dedicated aspiration needle. METHODS: All patients who underwent endoscopic transmural drainage of PFC from October 1998 to May 2006 were identified from the endoscopy database. Data were abstracted from the endoscopic procedure report and the patient records then placed in a JMP drive. All drainages were performed without EUS guidance after visualization of an obvious intraluminal bulge using a dedicated large-bore aspiration needle. The transmural tract into the PFC was dilated using a balloon with a diameter of 6 to 20 mm followed by subsequent placement of one or two 10-Fr double pigtail stents with or without nasocystic irrigation tubes. Successful entry was defined as entry allowing for the placement of stents. RESULTS: No significant difference in the complication rates was observed when they were analyzed for the following variables: age, gender, balloon diameter, presence of endoscopic impression, drainage approach, and size and type of fluid collection. CONCLUSION: Endoscopic transmural drainage of pancreatic fluid collections can be performed safely and effectively via the Seldinger technique without endoscopic ultrasound guidance. The study data will allow sample size calculations to be made if direct comparisons with this technique and others are undertaken.     

丙氨酸转氨酶正常且HBVDNA阴性代偿期肝硬化患者的肝组织病理特征及病毒载量分布

丙氨酸转氨酶（ALT）正常、实时PCR检测HBVDNA载量低于1000拷贝／mL的代偿期乙型肝炎肝硬化患者临床上相对少见。对于这些患者是否需要抗病毒治疗,目前存在很多争议。本研究通过对这些患者进行肝脏病理组织学、Cobas HBV DNA定量基线检查,了解其肝脏炎症、纤维化和病毒载量分布情况,为进一步治疗提供依据。     

微创小针刀内括约肌切断术治疗肛裂358例

为观察采用微创小针刀内括约肌切断术治疗陈旧性肛裂的效果,对358例陈旧性肛裂患者采用眼科虹膜小针刀内括约肌切断术治疗。结果显示,358例患者均一次性治愈,疗程5～8d,无术后并发症及后遗症;随访1年,均无复发。结果表明,小针刀微创术与其他内括约肌切断术相比,具有操作简便、治疗彻底、创伤小、疗程短,无术后并发症及后遗症等优点。     

芒针对脊髓损伤后尿潴留患者的尿动力学影响

目的:探索芒针在治疗脊髓损伤后尿潴留方面的临床意义。方法:2016年1月至2018年6月收治60例脊髓损伤后尿潴留的患者,分为芒针组和毫针组,每组30例,治疗穴位选取秩边和水道。芒针组男23例,女7例,年龄(52±9)岁,治疗予以芒针偶刺双侧穴位,并接电针仪30 min,频率3 Hz,治疗30 min;毫针组男24例,女6例,年龄(56±10)岁,治疗予毫针针刺双侧穴位后,留针30 min;两组的治疗频率都是隔日1次,在治疗2个月后通过分析两组患者达到平衡膀胱的时间、排尿日记、尿动力学指标和尿路感染情况等指标,发掘芒针在治疗该疾病的临床意义。结果:(1)平衡膀胱达到的时间:芒针组(39.5±1.2) d,毫针组(46.5±2.1) d;两组达到平衡膀胱的时间比较差异有统计学意义(P0.05)。(2)两组患者的排尿日记比较,通过组内比较,两组患者治疗后的每日导尿次数、每次导尿量、每日排尿次数、每次排尿量优于治疗前(P0.05);通过组间比较,在治疗后芒针组患者的每日导尿次数、每次导尿量、每日排尿次数、每次排尿量等指标的改善优于毫针组(P0.05)。(3)两组患者的尿路感染改善情况比较:两组患者治疗后尿路感染情况均改善,芒针组的尿路感染改善率优于毫针组(P0.05)。(4)两组患者尿动力学指标的比较:通过组内比较,两组患者治疗后的膀胱容量(VH2O),膀胱压力(pressure vesical,Pves),逼尿肌压力(pressure detrusor,Pdet),平均尿流速(Qave),最大尿流速(Qmax),膀胱顺应性(bladder compliance,BC)等优于治疗前(P0.05);通过组间比较,在治疗后芒针组患者的VH_2O、Pves、Pdet、Qave、Qmax、BC等指标的改善优于毫针组(P0.05)。结论:芒针在改善脊髓损伤后尿潴留患者的排尿状况、尿路感染和尿动力学方面要优于毫针针刺,对提高脊髓损伤后尿潴留患者生活质量具有积极意义,值得在临床上推广应用。