0.05), Vmax, Vmean, and D 2 had statistical difference between different age groups(P

Objective To evaluate the efficacy of transcatheter lipiodol chemoembolization therapy (TOCE) for HCC via inferior phrenic artery (IPA) and to analyse the location of the tumor feeding inferior phrenic artey. Methods Twenty five cases of HCC underwent the procedure of TOCE via the IPA, as well as the hepatic artery using Seldinger's method. The patterns of tumor growth included huge type in 12 cases, solitary nodular type in 8 cases and multiple nodular type in 5 cases. Hepatic artery and inferior phrenic artery chemoembolizations were performed in all cases. Results Inferior phrenic artery originated from celiac trunk in 16 cases (64%); abdomen aorta around celiac trunck in 8(32%). The sitesot tumors supplied by IPA in right lobe (Ⅶ,Ⅷ segment) were 23 cases and left lobe (Ⅳ segment) 2 cases. The cumulative survival rates of IPA chemoembolization for hepatocellular carcinoma were 84%(1 year) and 68%(2 years). No severe complications occurred. Conclusions TOCE of the IPA is a safe and effective method in the management of HCC supplied by IPA. When the tumor site is adjacent to diaphragm, hepatic ligaments or bare area, may arouse the blood supply by IPA, especially in no tumor staining or staining defect in hepatic artery angiography but tumor enhancement on CT, and increase of the level of serum ? fetoprotein.

Objective To determine the clinical efficacy and safety of domestic biliary metallic stents in the management of biliary obstruction. Methods 75 domestic biliary metallic stents were implanted in 66 of 72 patients with obstructive jaundice due to malignant (n=70) and benign stenoses (n=2). Results The technical successful rate was 92.7% (64/66). Palliation with rid of jaundice was achieved in 96.9% (64/66) within 1 month. The 30-day mortality rate was 3% (2/66). Early complications occurred in 7.6% (5/66). 44 patients were followed from 2 to 24 months after treatment. 33 (33/42) of 42 patients with malignancy died after a median survival of 5.3 months (range 2-23 months). The remaining 9 patients (9/42) remained alive with a mean follow-up of 11.6 months. The stent patency rates were 92.8%,89.9% and 79.4% at 3,6,12 months respectively. 6 patients (6/42) presented stent occlusion within a median period of 3 months. One of two patients with benign stenoses sustained a patency duration time of 24 months. One patient died 3 months after treatment. Conclusions The domestic biliary metallic stent implantation is efficacy and safety in the management of biliary obstruction.

PurposeSmall breast mass (diameter≤1 cm) is prone to misdiagnosis in clinic. This paper aims to evaluate a combined application of breast imaging reporting and data system (BI-RADS) and ultrasound elastography (UE) on small breast mass (diameter≤1 cm).Materials and MethodsA retrospective analysis was carried out on 231 patients with a total of 258 small masses (the maximal diameter ≤1 cm). Ultrasound BI-RADS was used for classiifcation while UE was used to adjust the results. The results were further compared with those of postoperative pathology. The curve of ROC was employed to evaluate the combined use on small breast mass.ResultsAmong the 258 small masses, 178 (69.0%) were benign masses and the rest 80 (31.0%) were malignant. The small masses which were evaluated as BI-RADS grade 3, 4 and 5 before the operation had positive prediction value for malignant masses of 10.3% (17/165), 60.5% (46/76) and 100.0% (17/17), respectively. After adjustment with UE, the values changed to 5.3%(9/169), 75.0% (54/72) and 100.0% (17/17), respectively. After adjustment with the combination method, the area under ROC curve in BI-RADS classification was 0.904, which was signiifcantly higher than that (0.827) before the adjustment (Z=2.83,P<0.05). ConclusionFor small breast mass (diameter≤1 cm), mass of BI-RADS grade 3 has higher positive prediction value. But after adjustment with UE, the positive prediction value of mass of BI-RADS grade 3 tends to be lower, whilst that of mass of BI-RADS grade 4 increases, thus promoting the efficiency of ultrasound BI-RADS classification for small breast mass and contributing to the identiifcation of benign and malignant small breast masses.

Objective To explore the value of computed tomography (CT)and magnetic resonance imaging (MRI)in the diagno-sis and delineation of the extent of malignant external otitis (MEO).Methods Clinical manifestations and imaging features of 10 pa-tients with definite diagnosis of MEO were collected and analyzed.Plain and contrast-enhanced CT of the ear were performed on all 10 patients,of which 6 patients also received MRI scans.Results Abnormal soft tissue opacity within the external auditory canal and involvement of surrounding structures were found in all 10 patients.Bone erosion of the external auditory canal was showed in 7 pa-tients.Other CT findings included bone erosion of skull base and intracranial involvement.Abnormal soft tissue of the external audi-tory canal,effusion in the mastoid cavity and medullary abnormalities were showed very well on MR images in 6 patients while the cortical bone erosion was not well showed.Conclusion Imaging features of the lesions in the external auditory canal,bone erosion of skull base and intracranial involvement play crucial roles in the diagnosis and delineation of the extent of the lesion in patients with MEO.

Objective: To establish the standardized management mode for emergent medicines of inpatient area based on JCI. Methods:The expiry verification data of emergent medicines in hospital wards were collected from 2013 to 2015. The number and the amount of emergent medicines expired in the last three months in each calendar month during the three years were analyzed, the exist-ing problems in the management mode were found out and gradually optimized using PDCA cycle. Results:From 2013 to 2015, the re-placement amount of emergent medicines expired in the next month was 3497. 37 yuan. The number of emergent medicines expired in current month was 62. A total of 420 times of emergent medicines didn' t meet the requires of expiry verification from 2013 to 2015. After the check-in form redesign for emergent medicines and the standardization of replacement process, the number of expired medi-cines in the rescue carts was reduced, and the validity and quantity of drugs in all the rescue vehicles could be clearly shown in the new form. Conclusion:The standardization of emergent medicine management model can guarantee the safety of emergent medicines used in patients.

Objective: To study the dosages of capsules commonly used in children to provide reference for the addition of capsule specification for children.Methods: According to the application situation of capsule dosages commonly used for the inpatients in one children's hospital from January 1, 2013 to September 1, 2016, and combined with the usage rates of various drugs with different dosages, the addition of the minimum dosage of capsules was proposed.Results: Totally 10 species of commonly used capsules were selected from the children's hospital, and among them, 4 ones met the requirements of clinics, and the other 8 ones needed the specification addition, including clostridium butyricum capsules (210 mg) and polysaccharide ferric complex capsules (25 mg).Conclusion: The existing capsule specification can not fully meet the clinical requirements in the children's hospital.Therefore, appropriate dosage adjustments are still needed.

Objective To explore the clinical features and perioperative treatment effects of colorectal cancer in elderly patients.Methods Retrospective analysis of clinical data especially focusing on perioperative treatment from 104 elderly patients with coloreetal cancer were performed.Results A total of 99 patients (95.2%) were cured or improved at discharge.Perioperative pulmonary infection occurred in 13 cases (12.5%), of whom 6 cases (5.8%) suffered from respiratory failure.Lower extremity deep venous thrombosis occurred in 3 cases (2.9%), incision infection in 6 cases (5.8%), wound dehiscence in 2 cases (1.9%), intestinal fistula in 1 case (1.0%) and gastroparesis in 1 case (1.0%).About 5 cases (4.8%) died from multiple organ failure.Conclusions Old age is not a contraindication in surgical treatment for colorectal cancer.Paying attention to accurate and timely treatment in perioperative peroid can reduce postoperative complications and improve patients' quality of life.

Objective To discuss the clinical value of interventional management before surgical therapy for massive gastrointestinal hemorrhage, and to compare the clinical efficacy and re-bleeding rate between hypophysin infusion group and embolization group. Methods During the period of June 1998-Apr.2009, 31 patients with massive gastrointestinal hemorrhage in our institution underwent preoperative interventional managements before they received surgical treatment. According to DSA manifestations, the patients underwent trunsarterial hypophysin infusion or transcatheter embolization as interventional management. The clinical efficacy of interventional procedures and its influence on the surgery were evaluated, and the hemostasis rate and re-bleeding rate were compared the two kind of intervention managements. The numeration data were analyzed with Fisher's exact test, and the SPSS 11.0 was used as statistical software. Results The interventional managements were successfully performed in all the 31patients, with a total hemostasis rate of 83.9% (26/31) and a total re-bleeding rate 30.7% (8/26). The hemostasis rate and re-bleeding rate of hypephysin infusion group and embolization group were 69.2% (9/13), 94.4% (17/18) and 44.4% (4/9), 23.7% (4/17), respectively. All the 31 patients received surgery after interventional therapy, of which selective operation was carried out in 20. Neither surgery-related or intervention-related serious complications nor death occurred. Conclusion Preoperative interventional managements can provide patients with massive gastrointestinal hemorrhage with valuable chance of a successful surgery, enable the physician to take a selective operation to replace an emergency one, as a result, the surgical risk will be greatly reduced. Therefore, it is worth popularizing the preoperative interventional managements in clinical practice.

Objective To compare the diagnostic value of ultrasound,molybdenum target,magnetic resonance(MRI)and single examination for breast cancer.Methods From January 2017 to February 2018,100 patients with suspected breast cancer in Lishui Central Hospital were selected in the study.All patients were detected by ultrasound,mammography and MRI three ways for diagnosis.The results were verified with postoperative pathologic results as the standard.The diagnosis accuracy of three ways for breast cancer were analyzed.Results The detection accuracy of three ways joint detection in patients with breast cancer was the highest(91.00％),which was significantly higher than that of ultrasound(63.00％),mammography(72.00％)and MRI(72.00％)in single mode,the differences were statistically significant(χ2 =22.364,20.154,16.032,all P<0.05).Conclusion Ultrasonography,molybdenum target X ray and MRI have their respective advantages in the process of breast cancer differentiation and diagnosis,and the detection rate can be significantly improved if combined use.