ObjectiveTo explore the possibility of intrahepatic biliary perfusion by contrast enhanced ultrasonography via bile duct. MethodsSixteen rabbits weighing 2 000-2 500 g were studied. A 22 gauge catheter was inserted in the common bile duct by surgery. The rabbits were divided into 4 groups according to the concentration of contrast agent, including group A:1/100 of standard concentration; group B:1/200 of standard concentration; group C:1/400 of standard concentration; and group D:1/800 of standard concentration. We observed the filling status, presence of outflow of contrast enhanced signal and satisfactory enhanced time after the injection of contrast agent via the catheter in common bile duct. ResultsFive milliliter of contrast agent was injected in each rabbit. The number of homogeneous filling in group A, B, C and D was 4, 4, 3 and 0 respectively. The number of presence of outflow of contrast enhanced signal in group A, B, C and D was 4, 1, 0 and 0 respectively. The satisfactory enhanced time in group A, B, C and D was (340±29) s, (284±37) s, (82±8) s and 0 s respectively. There was no statistical difference in the satisfactory enhanced time between group A and B (P=0.06) while significant difference in the satisfactory enhanced time between group A and C (P < 0.01), and between group B and C (P < 0.01) was found. ConclusionIt is possible to perfuse the intrahepatic biliary system by sonographic contrast agents via bile duct, and 1/200 of standard concentration is a proper concentration of contrast agent to achieve satisfactory imaging.
ObjectiveTo investigate the causes of the complications and prevention strategy by analyzing occurrence of prosthesis-related complications after extensible semi-joint prosthesis replacement for lower limbs osteosarcoma in children. MethodsEleven children with lower limbs osteosarcoma underwent resection of tumor and replacement of the extensible semi-joint prosthesis between May 2006 and October 2012. There were 6 boys and 5 girls, with an average age of 9.3 years (range, 7-12 years). The lesions located at the distal femur in 6 cases, at the proximal femur in 2 cases, and at the proximal tibia in 3 cases. The disease duration was 2-8 months (mean, 3.6 months). According to the Enneking stage, 3 cases were rated as stage ⅡA and 8 cases as stage ⅡB. The pulmonary CT and ECT results showed no pulmonary metastasis or multi spots before operation. All patients received preoperative chemotherapy treatment for 4 times. ResultsPrimary healing of incision was obtained in 10 cases. Infection occurred in 1 case at 1 week after operation, and was cured after symptomatic treatment. Nine patients received postoperative chemotherapy for 12 times, 2 patients for 2 times and 4 times respectively. One case died of multiple metastasis; in 3 cases of pulmonary metastasis, 2 cases died and 1 case survived after resection of metastatic lesion. Eight survival cases received a follow-up of 25-89 months (mean, 42.5 months). Loosening and dislocation of the proximal femoral prosthesis occurred in 1 case, loosening and subsidence of the distal femoral prosthesis in 1 case, subluxation in 1 case, and retraction in 1 case. The incidence of prosthesis-related complications was 50%. Lengthening operation was performed on 3 cases for 1 time, and on 1 case for 2 times. And 4 cases did not undergo lengthening operation. According to Enneking function evaluation standard after malignant tumor limb-salvage surgery, the results were excellent in 1 case, good in 3, fair in 3, and poor in 1 at last follow-up with an excellent and good rate of 50%. ConclusionThe prosthesis-related complications include loosening and subsidence, dislocation, knee instability, and retraction after extensible semi-joint prosthesis replacement for lower limbs osteosarcoma. The prosthesis-related complications can be reduced by the improvement of prosthesis design and manufacture, and the use of intraoperative bone cement, artificial mesh, and postoperative restrictive brace.
Ultrasound Medicine has been through a rapid development during the past half century and has become an indispensable discipline for prophylactic medicine and clinical practice. Nowadays, the needs for ultrasound medicine diverse which leads to many challenges to the existing ultrasound physician scanning - diagnostic mode, including labor-intensiveness for the ultrasound physician, lacking of hierarchical management, contradiction of quality and quantity, irrational allocation of medical resources, and so on. This paper discussed several issues including the current situation of ultrasound education, domestic and western ultrasound work mode, necessity for ultrasound physician- sonographer integrated work mode, as well as the feasibility of standardized sonographer training. Combined with the experience of the West China Hospital, explore a Chinese way to carry out sonographer education and training program and try out ultrasound physician-sonographer integration mode.