The Supraclavicular Fossa Ultrasound View for Central Venous Catheter Placement and Catheter Change Over Guidewire

The supraclavicular fossa ultrasound view can be useful for central venous catheter (CVC) placement. Venipuncture of the internal jugular veins (IJV) or subclavian veins is performed with a micro-convex ultrasound probe, using a neonatal abdominal preset with a probe frequency of 10 Mhz at a depth of 10-12 cm. Following insertion of the guidewire into the vein, the probe is shifted to the right supraclavicular fossa to obtain a view of the superior vena cava (SVC), right pulmonary artery and ascending aorta. Under real-time ultrasound view, the guidewire and its J-tip is visualized and pushed forward to the lower SVC. Insertion depth is read from guidewire marks using central venous catheter. CVC is then inserted following skin and venous dilation. The supraclavicular fossa view is most suitable for right IJV CVC insertion. If other insertion sites are chosen the right supraclavicular fossa should be within the sterile field. Scanning of the IJVs, brachiocephalic veins and SVC can reveal significant thrombosis before venipuncture. Misplaced CVCs can be corrected with a change over guidewire technique under real-time ultrasound guidance. In conjunction with a diagnostic lung ultrasound scan, this technique has a potential to replace chest radiograph for confirmation of CVC tip position and exclusion of pneumothorax. Moreover, this view is of advantage in patients with a non-p-wave cardiac rhythm were an intra-cardiac electrocardiography (ECG) is not feasible for CVC tip position confirmation. Limitations of the method are lack of availability of a micro-convex probe and the need for training.     

PSCA与前列腺癌研究进展

前列腺干细胞抗原(prostate stem cell antigen,PSCA)是一种前列腺癌相关肿瘤抗原,也是一种GPI(gly-cosyl phosphatidylinositol)锚定蛋白,通过其C端的GPI锚定结构锚定到细胞膜表面.PSCA在正常前列腺组织中的表达较低,提高的PSCA表达伴随着增加的肿瘤分期、分级以及雄激素非依赖性和转移癌的形成,且不随癌症进展而降低,是前列腺癌诊断和治疗的理想靶抗原.动物实验显示,PSCA抗体和疫苗可能在前列腺癌免疫靶向治疗中具有重要价值.     

The Diagnosis of Early Carcinoma of the Prostate

Careful palpation of the gland is a very important examination procedure in the detection of early carcinoma in the prostate. The finding of a suspicious area requires additional investigation, which must include histological examination of tissue from the suspected lesion. Adequate material for histological studies can usually be obtained by needle biopsy. The percutaneous perineal approach has been found satisfactory for this purpose. In those whose life expectancy is 10 years or more, prostatic carcinoma in its early stages should be treated by radical prostatectomy. For more advanced lesions or for patients whose life expectancy is less, hormonal therapy may be used.