超声引导徒手穿刺活检在乳腺癌诊断中的应用

目的探讨高频超声引导徒手穿刺活检在乳腺癌诊断中的应用价值。方法回顾性分析36例乳腺癌经高频超声引导自动活检枪徒手穿刺活检情况。结果36例可疑乳腺癌经超声引导徒手穿刺活检均取得满意的病理材料,病理诊断为乳腺癌,与术后病理结果一致,诊断率100%,其中1例未明确病理组织学分型,对组织学分型诊断率为97.2%。所有穿刺活检病例均未出现严重并发症。结论乳腺癌应用高频超声定位徒手穿刺活检可以获得明确的病理诊断,操作简单方便、安全可靠。     

Physician assistants in academic radiology: the harborview experience

We describe a model of how physician assistants can be used in an academic medical center to expand radiologist productivity, and to enhance the departmental academic and educational missions. At Harborview Medical Center, following a training program and graduated responsibility under supervision, physician assistants provide initial interpretation of radiology studies, consultation to referring physicians, and perform less complicated interventional procedures. Acceptance of physician assistants by the radiologists, radiology residents, and referring physicians has been high. Although the impact of physician assistants on departmental clinical productivity is difficult to measure, our data suggest that radiologists are more efficient when physician assistants are assigned to service, both in terms of numbers of studies interpreted, and timeliness of reporting and billing. As a result of the success of our program, we believe that physician assistants can have an important role in radiology practice.     

CT导引下胸部病变穿刺活检不同方法的临床探讨

目的探讨胸部病变穿刺活检联合同轴针吸对提高阳性率减少并发症的价值。方法回顾性分析CT导引下106例胸部病变三种不同穿刺方法的阳性率及并发症。结果单纯针吸组32例,检出恶性病变23例,良性4例,阳性率为84.3%,并发症为15.6%;单纯活检组27例,检出恶性病变15例,良性7例,阳性率为81.5%,并发症为48.1%;活检同轴针吸组47例,检出恶性病变28例,良性15例,阳性率91.5%,并发症为29.7%。结论活检联合同轴针吸是提高阳性率减少并发症的较好的活检方法,它既弥补了活检的缺点,又集中了针吸的优点,是值得推广的活检方法。     

经子宫动脉氨甲蝶呤灌注及栓塞 在宫颈妊娠保守治疗中的应用

目的探讨经子宫动脉氨甲蝶呤灌注化疗及栓塞术在宫颈妊娠保守治疗中的应用价值.方法 6例宫颈妊娠患者,孕龄36～68天,经阴道超声检查明确诊断后,行双侧子宫动脉氨甲蝶呤灌注及栓塞治疗.结果所有患者均一次治疗成功,术后患者的阴道出血明显减少或中止,血β-HCG水平迅速下降.患者的宫颈形态及月经周期于治疗后4个月内恢复正常.结论子宫动脉氨甲蝶呤灌注化疗及栓塞术是保守治疗宫颈妊娠的有效方法.     

静脉溶栓联合导管碎栓和切栓治疗急性大面积肺栓塞

目的评价静脉溶栓联合导管碎栓和切栓治疗急性大面积肺栓塞的临床疗效和安全性。方法对19例急性大面积肺栓塞患者，采用下腔静脉滤器置入、肺动脉导管碎栓和静脉溶栓加低分子肝素抗凝治疗，19例中4例加用了Straub Rotarex导管血栓旋切术。结果19例共行21次治疗。18例经介入治疗后胸闷、紫绀症状均明显改善，肺动脉中央分支血流恢复通畅，血氧饱和度由术前平均86％（74％～96％）上升到治疗后的平均97％（94％～100％）。肺动脉压力从术前的（334-5）mmHg（1mmHg=0．133kPa）下降到术后的（254-5）mmHg（t=13．2，P〈0．01）。l例双侧肺动脉主干大块血栓栓塞的患者，介入治疗无效，后经胸外科手术取栓未能成功，患者死亡。4例成功地采用了Straub Rotarex旋切治疗肺动脉血栓，未出现并发症。结论采用导管碎栓和血栓旋切等介入技术联合静脉溶栓抗凝治疗，是治疗急性大面积肺动脉栓塞的有效而且安全的方法。     

肝动脉解剖变异在中晚期肝癌介入治疗中的意义

目的 探讨放射学肝动脉解剖变异及其在中晚期肝癌介入导管治疗中的临床意义。方法 回顾性分析125例中晚期肝癌肝动脉造影表现及其介入治疗资料。结果 125例中107例(85．6％)有典型肝动脉分布。肝动脉变异18例(14．4％)，其中肝右动脉变异10例(8％)，而又以肝右动脉始于肠系膜上动脉者最多，占6．4％。副肝左动脉变异1例(0．8％)。肝左动脉和肝右动脉同时变异2例(1．6％)。肝总动脉变异3例(2．4％)。胃十二指肠动脉起自肝右动脉和腹腔动脉各1例(1．6％)。对123例成功进行了肝动脉化疗栓塞，2例肝右动脉变异因角度关系超选插管未成功。结论 认识肝动脉解剖变异有助于提高插管的成功率和中晚期肝癌的介入治疗疗效。     

Revascularization of a thrombosed aortopulmonary shunt with the use of the AngioJet thrombectomy system.

We report the use of the AngioJet F140 rheolytic catheter to recannalize an acutely thrombosed aortopulmonary shunt in a 21-year-old female with palliated, complex congenital heart disease. After extracting the thrombus that filled the entire length of the shunt, three stents were placed at sites where the lumen was compromised by distortion or thrombus. Unobstructed flow was restored to the left pulmonary artery that persisted at 1-year follow-up.     

Comparison of CT-guided sclerotherapy with using 95% ethanol and 20% hypertonic saline for managing simple renal cyst.

OBJECTIVE: We wanted to compare the efficacies of 95% ethanol and 20% hypertonic saline (HS) sclerotherapies that were performed in a single session under CT guidance for the management of simple renal cysts. MATERIALS AND METHODS: A prospective series of 74 consecutive patients (average age: 57.6 +/- 8.1 years) with simple renal cysts were enrolled in this study. They were randomized into two groups and 95% ethanol or 20% HS, respectively, corresponding to 25% of the aspiration volume, was injected. Treatment success was determined six months later with follow-up clinical evaluation and performing ultrasonography. RESULTS: The sclerotherapy was accepted as technically successful without major complications in all except two patients who were excluded because of a communication between the simple renal cyst and the pelvicalyceal collecting system. Thirty-six patients in the ethanol group received sclerotherapy with 95% ethanol and 36 patients in the HS group underwent sclerotherapy with 20% HS. The complete regression ratio of the ethanol group was significantly higher (94% versus 72%, respectively) than that of the HS group. There was one patient with partial regression in each group. The failure ratio of the ethanol group was significantly lower (3% versus 25%, respectively) than that of the HS group. CONCLUSION: Ethanol sclerotherapy under CT guidance is a successful and safe procedure and it can be used for the treatment of simple renal cysts. Sclerotherapy with 95% ethanol is more effective than 20% HS sclerotherapy. Sclerotherapy with HS may be an option for patients preferring to undergo a less painful treatment procedure.     

Transjugular intrahepatic cavoportal shunt for Budd–Chiari syndrome

Budd–Chiari syndrome (BCS) is characterized by obstruction of the hepatic venous outflow tract. Therapeutic options for BCS are limited. We report a case of a 21-year-old woman with protein S and C deficiency with gross ascites. Treatment with transjugular intrahepatic portosystemic shunt (TIPS) was attempted, which revealed occluded hepatic veins, so transcaval TIPS was performed. No serious procedure-related complication occurred. After successful shunt creation, the patient's symptoms subsided and she was discharged and followed up for 6 months.