Extramammary Paget′s disease (EMPD) is a rare skin malignant tumor. Surgery is an important treatment for this disease, but the postoperative recurrence rate is still high, due to its clinical and pathological features and surgical methods. This review summarizes recent advances in reducing postoperative recurrence rate of EMPD.

Objective To evaluate the feasibility of chest digital tomosynthesis(DTS)for lung lesion screening by comparing the effective dose of chest DTS with chest digital radiography(DR),low-dose MSCT and MSCT examinations.Methods The Fluke lung/chest phantom underwent posterior-anterior (PA),left lateral(LAT)chest DR and DTS with automatic exposure control technique.Using RTI DoseGuard and WinODS,the dose area product(DAP)and effective dose of PA,LAT and total DTS were calculated.CareDose technique was used for MSCT and low-dose MSCT scans,the dose length products (DLP)was acquired.According to the DLP to E(k)conversion coefficient in ICRP 103,the effective dose of low-dose MSCT and MSCT were calculated.Paired t test was used for comparison of the mean effective dose of DTS,DR and low-dose MSCT.Results The mean effective dose was 0.1 3 mSv for chest DR and 0.11 mSv for DTS examination.The mean effective dose of low-dose MSCT and MSCT scans were 1.13 mSv and 6.38 mSv.The effective dose of chest DTS was comparable to that of chest DR,and was approximately 1/10 and 1/60 times lower than that of low-dose MSCT and MSCT scans.There was no statistical difference between chest DTS and DR(t =3.514,P ＞0.01),and there was a significant difference between chest DTS and low-dose MSCT(t =178.769,P ＜0.01).Conclusion DTS is a new X-ray tomography which has the advantage of low radiation dosage in chest examination for lung lesion screening comparing with low-dose MSCT.

Objective To study the development of medical imaging in Shandong province and identify existing problems. Methods 378 secondary hospitals and above were surveyed with questionnaires and other means for a general picture of their radiology departments. The survey covered medical imaging examinations, human resources and equipment configurations. Results The recent five years have found a rapid growth of a variety of medical imaging examinations, digital imaging in dominance, high-end equipments as the mainstream, sufficient staffing, shortage of high-level talents in these hospitals. Conclusion The medical imaging examinations should be regarded as justified and reasonable, the competence of hospital staff should be upgraded, and operation of medical imaging examinations should be normalized.

Objective To explore the value of MR imaging-guided percutaneous lumbar discectomy and discolysis with oxygen-ozone mixture for treatment of posterolateral lumbar disc herniation via a new puncture approach of facet joint medial route. Methods All 114 lumbar intervertebral discs in 103 patients were diagnosed as posterolateral lumber disc herniation by CT or MRI, which were located at the levels of L3-4 in 5 cases, LA-5 in 87 cases and L5-S1 in 22 cases. The procedure was guided under 0. 23 T open magnetic resonance with iPath 200 optical tracking system. A 14 G MR-compatible needle was punctured into the disc center via a new puncture approach of facet joint medial route. The therapy steps were as follows: firstly, cut nucleus pulposus and inject 6 ml oxygen-ozone mixture of 60 μg/ml in the disc center;secondly, retreat the needle to the local prominence, cut prominent part and inject 6 ml oxygen-ozone mixture of 60 μg/ml. Thirdly, retreat the needle to the periradicular nerve root, inject 15 ml oxygen-ozone mixture of 40 μg/ml and 4 ml pain-block liquid. All patients were followed up at 3 days, 1 month, 3 months and 6 months after operation, evaluated for the effect of treatment with the modified Macnab criteria, and the results were compared with the χ2 test. Results All procedures were successfully performed. Intraoperative dural injury occurred in 5 cases. Postoperative infection of intervertebral space occurred in 2 cases. The clinical effective rate was 96. 1% (99/103), 84.5% (87/103), 94.2% (97/103), 95.1% (98/103)respectively at 3 days, 1 month, 3 months and 6 months after operation, and the differences were signifieant (χ2 = 12. 942, P = 0. 005 ) . Conclusion MR imaging-guided percutaneous lumbar discectomy and discolysis with oxygen-ozone mixture via facet joint medial route is a minimally invasive, safety and effective method for the treatment of posterolateral lumbar disc herniation.

Objective To explore the value of MR imaging-guided percutaneous cervical discectomy and discolysis with oxygen-ozone mixture for treatment of cervical disc herniation.Methods Eight herniated cervical discs in 7 patients were diagnosed by MRI, including 5 discs of lateral protruding type, 2 discs of paramedian protruding type and one disc of central protruding type.All patients underwent MR imaging-guided percutaneous cervical discectomy and discolysis with oxygen-ozone mixture.The procedures were guided by a set of 0.23 T open MR system mounted with iPath 200 optical tracking system.The herniated portion of the disc was punctured with a 14 G MR-compatible needle in the healthy side via anterolateral oblique route.The interventional steps were as follows; firstly, cut herniated part with percutaneous discectomy probe and inject 2ml oxygen-ozone mixture of 60 μg/ml; secondly, retreat the needle to the disc center, resect nucleus pulposus, and inject 2 ml oxygen-ozone mixture of 60 μg/ml.All patients were followed up for 6 months, with 4 patients by telephone and 3 patients in outpatient clinic.The effect of treatment was evaluated according to Williams postoperative assessment standard.Results All procedures were performed successfully.The clinical outcome was evaluated as excellent in 5 cases, good in 1 case and fair in 1 case.The total ratio of excellent and good was 85.7%.No serious complication occurred expect 1 case with intraoperative paroxysmal pain.Conclusion MR imaging-guided percutaneous cervical discectomy and discolysis with oxygen-ozone mixture was a safe, effective and minimally invasive method for the treatment of cervical disc herniation.