Volume 90  ·   Issue 17  ·  2010

In recent years, endovascular technique has gradually become the main technique for the treatment of vascular diseases. Because it is difficult for vascular surgeons in China to obtain good basic technical training in vascular lumen, cases of serious renal function damage caused by improper use of contrast agent often occur. Therefore, the author is willing to give a brief introduction to this problem.

Objective To report the contrast medium induced pancreatitis after angiography or endovascular therapy, analyze the possible cause of this complication, the treatment specialty and the prognosis. Method The patients suffered from contrast medium induced pancreatitis after angiography or endovascular therapy during last 10 years were retrospectively analyzed. The patients' comorbidity, the onset time of the pancreatitis, the specialty of the pancreatitis, the treatment method and the prognosis were documented. The relative literature was retrieved and reviewed. The clinical data was compared with the relative literature and analyzed. Results Three cases of contrast medium induced pancreatitis were documented. One case was a young man, received angiography because of renal artery stenosis. He was suffered from moderate abdominal pain 2 hours after the procedure. Pancreatitis of edema type was confirmed by CT scan. He recovered thoroughly after the medical treatment. One case was an old man, underwent angiography for renal artery stenosis and abdominal aortic aneurysm. He was suffered from acute abdominal pain during the procedure. The CT scan revealed as edema pancreatitis. He died from cardiac infarction during the treatment. The last case was an old female, suffered from sustained abdominal distension after endovascular treatment of endoleak post AAA EVAR. Edema pancreatitis was confirmed by CT scan. The symptom was not alleviated well after the treatment. Finally she was died from MOSF. Conclusion The incidence of contrast medium induced pancreatitis is relatively low. It's not easy to detect in early stage.Early diagnosis and treatment is the key to improve the therapeutic effect. The prognosis of patient with multiple comorbidity is poor.

Objective To compare the efficacies of different hydration strategies in protecting the renal function of the arteriosclerosis obliterans(ASO) patients undergoing endovascular treatments. Methods 40 patients who underwent endovascular treatments for arteriosclerosis obliterans of lower extremities in the Vascular Surgery Department of PLA Hospital from January 2009 to October 2009 were divided into normal (eerumcreatinine≤110 μmol/L) and abnormal (serum creatine ＞ 110 μmol/L) groups according to their baseline serum concentration of creatinine before treatments. Each group was treated by different hydration strategies 12 h before procedures. Changes of serum creatinine and creatinine clearance were measured 6,24,48 h after procedures to evaluate the changes of renal function and the effects of different hydration strategies. Results No contrast-induced nephopathy (CIN) was observed among the 40 patients. There are significant differences between normal saline hydration group and control group in the changes of serum creatinine and creatinine clearance 24 h and 48 h after exposure to contrast medium for the normal renal function patients ( P ＜ 0. 05 ). For the patients pre-existing renal dysfunction, no significant difference was found between Sodium Bicarbonate + Saline group and Saline group in the changes of Scr and Ccr 6,24,48 h after exposure to contrast medium(P ＞0. 05). Conclusion Sodium chloride provides a good efficacy for preventing the adverse effect of contrast medium to the renal function of theASO patients. For the patients pre-existing renal dysfunction, Combination hydration with sodium bicarbonate is not more effective than normal saline alone in preventing contrast-induced renal dysfunction.

Objective To explore the surgical treatment method and outcome for subaxial cervical spine metastatic tumor. Methods We retrospectively analyzed 7 cases of subaxial cervical spine metastatic tumor treated at our hospital between 2002 and 2007. There were 3 male and 4 female patients. The primary lesions included 1 lung cancer, 1 renal cancer, 1 liver cancer, 2 gastric cancers and 2 breast cancers. All cases were treated with anterior vertebrectomy, reconstruction of cervical spine stability with mesh cage and plate fixation. Preoperative and 3-month postoperative VAS scores of neck pain and neurological status of Frankel classification were analyzed statistically. Cervical spine stability was observed by radiography during follow-up. Results The preoperative and postoperative VAS scores of neck pain were 7. 4 ± 0. 8 and 1.8 ± 1.2 respectively. There was obvious statistical difference between two scores ( t = 15. 11, P = 0. 000). The post-operative neurological status of Frankel classification improved by one to two grades. The mean followup period was 18 months except for one patient dying from multiple organ failure at 9 months post-operation. Radiology showed satisfactory cervical spine stability during follow-up. Conclusion For treating subaxial cervical spine metastatic tumor, anterior vertebrectomy, reconstruction with mesh cage and plate fixation is an effective method to relieve clinical pains and improve neurological functions by complete spinal cord decompression and cervical stability reconstruction.

Objective To evaluate the clinical efficacy of Metzenbaum scissors in the transcervical incision of a complete septate uterus. Methods Eight patients with a complete septate uterus were identified and recruited. The age range was 24 to 39 years old. After diagnosis by hysteroscopy, the transcervical incision was performed by Metzenbaum scissors and followed by hysteroscopic incision of corporal portion. The associated diseases were treated using laparoscopy. Results All patients were successfully treated and the operation duration was 5-10 minutes. The postoperative period was uneventful and there was no perforation, pelvic organ damage or water intoxication. Three months later, hysteroscopy revealed no uterine scarring or adhesion. And the shape of uterine cavity was normal. Conclusion Using Metzenbaum scissors for transcervical incision of cervical portion of complete septate uterus, followed by hysteroscopic incision of corporal portion, is convenient, fast and safe. This approach has no effect upon the growth of endometrium.

Objective To observe the expression change of ANK protein in normal and degenerative vertebral endplate chondrocytes and explore the correlation between ANK gene expression and intervertebral disc degeneration. Methods Cartilaginous endplates of 45 patients were divided into experiment group (28 with cervical spondylotic myelopathy including 17 males and 11 females) and control group (17 with fracture or dislocation of cervical spine including 10 males and 7 females). The MRI examinations revealed that all the endplate in control group were grade 0 and grade Ⅰ-Ⅲ in experiment group according to Miller's classification. Pathological examination demonstrated that intervertebral discs were grade Ⅰ in control group and grade Ⅲ-Ⅴ in experiment group according to Thompson's classification. The morphological appearances and calcification of cartilaginous endplates were observed by HE and Von kossa staining.Immunohistochemical SABC staining, RT-PCR and Western blot were used to detect the ANK mRNA and protein expression in chondrocytes. Results More calcium deposit could be observed in the experiment group than in the control group by Von kossa staining. ANKH protein was found positive in cell membrane of chondrocytes. Compared with chondrocytes of control group, the expression of ANK mRNA in experiment group markedly decreased (P ＜ 0. 05). And the level of ANK protein expression decreased too ( P ＜ 0. 05 ).Conclusion Following the degeneration of cartilaginous endplate, the intervertebral disc degeneration worsened and the expression level of ANK decreased in vertebral endplate chondrocytes. Also calcification is positively correlated with the degree of intervertebral disc degeneration. Modulating the expression of ANK in endplate chondrocytes may be a new approach to treat the degeneration of intervertebral disc.

Objective To investigate the correlation between the differential expression of 60 000SSA epitopes in minor salivary glands(MSG) from patients with primary Sj(o)gren's syndrome (pSS) and glandular inflammation. Methods The screening and soluble expression of single-chain fragment V monoclonal antibodies (Scfv McAb) against SSA antigen epitopes ( P1: 480-494, P2: 310-323 and P3: 230-241 )were performed by phagmid antibody expression system. The expression of epitopes was detected by immunohistochemical assay (IH) in minor salivary glands from these patients. The correlation between epitopes expression and glandular inflammation was analyzed quantitatively. Results Immunohistochemical assay of MSG with McAb against P1-P3 epitopes showed that the epithelial cells of glandular tubes and striated duct were stained in membrane and cytoplasm. The expression of P1 epitope was higher than the other two in grading score (x2 = 12. 94, P ＜ 0. 01 ). And a positive correlation was found between the extent of glandular infiltration and the grade of P1 epitope expression(t =2. 27, P ＜0. 05) but not with P2 or P3 epitope. Conclusion Aberrant redistribution of intracellular SSA antigen epitopes onto the cell membrane of involved cells may break the immune tolerance and thus induce the production of pathogenic autoantibodies involved in triggering and maintaining the tissue-specific autoimmune response in pSS MSG. A significantly high membranous expression of P1 and a positive correlation between P1 and the inflammation of MSG suggest that P1 may be the dominant determinant of the antigen-driven immune response in pSS.

Objective To determine the value of reoperation in the treatment of recurrent gastric cancer. Methods Clinical and survival data of 85 patients undergoing reoperation for recurrent gastric cancer from January 1986 to December 2003 were studied retrospectively. Results Among 85 cases, there were 46 cases with recurrence within the stump stomach and 58 cases recurred within 2 years post-operation.Resection was performed in 45 patients including 34 cases treated by radical resection and 11 cases by palliative residual stomach resection. The 1, 3, 5-year survival rate of 34 cases after radical resection was 86%, 57% and 21% respectively. The mean survival time of palliative and comprehensive treatment cases was 16 months (range: 6-26) while all patients undergoing reoperation without resection died within 6 months post-operation. Conclusion An early diagnosis of recurrent gastric cancer depends on frequent reexaminations. Most postoperative recurrent gastric cancers, within the residual stomach, may be treated by re-operation.

Objective To summarize the anesthesia managements on 63 CAD patients undergoing 1-stop hybrid revascularization from July 2007 to June 2009 in Fuwai Hospital Methods ECG, direct BP, SpO2, PET CO2, CVP and body temperature were monitored during anesthesia. The management of intraoperative anesthesia should preferably use a small dosage of opioids with inhalation or intravenous anesthesia. At the same time , specific anticoagulation management was administered. Results The hemodynamics were stabilized. the time of tracheal intubation were shorter. 6 patients were immediate extubated in the operating room with application of fast-track technology. No patient died. Conclusions Such minimally invasive surgery has little effect on the circulation. The difficulty of anesthetic management is smaller. Specific anticoagulation management is administered. Implementation of the Fast-track technology can demonstrate the further advantages in such surgery.

Objective To evaluate the differences of clinical efficacy between intraperitoneal and intravenous chemotherapy. Methods The literature database was extensively searched to retrieve the randomized controlled trials with a relevance of study goal The strict inclusion and exclusion criteria were formulated. And the original studies were selected. After a quality evaluation, the data were extracted. The Cochrane collaboration Revman 4. 2 version software was used for meta-analysis. Results Five clinical studies were included and there were a total of 1 229 eligible patients. Intraperitoneal chemotherapy and intravenous chemotherapy groups were compared: (1) 2 and 3-year progression-free survival (PFS)increased, 2, 3 and 5-year overall survival (OS) increased. The difference was significant enough so that definite conclusions could be drawn; (2) Among the six indicators of unpleasant chemotherapeutic effects (leucopenia, anemia, thrombopenia, GI tract reactions, neurotoxicity and fever), the occurrence of gastrointestinal reaetion increased. The difference was significant enough so that definite conclusions could be drawn. And the remaining five indicators had no statistical significance so that definite conclusions could not be drawn. Conclusions For patients with epithelial ovarian cancer ( Stages FIGO Ⅱ -Ⅳ ) undergoing previously a satisfactory tumor reduction surgery ( postoperative residual lesions ＜ 1 to 2 cm), intraperitoneal chemotherapy can improve their 2 and 3-year PIS rates and the 2, 3 and 5-year OS rates; Intraperitoneal chemotherapy has not reduced the side effects. But there is an elevated occurrence of gastrointestinal reactions.

Objective To observe the effect of different analgesia combined with low molecular heparin (LMWH) on hameorheology and cogulation in patients undergoing total hip replacement (THR).Methods Patients undergoing THR with spinal combined epidural anesthesia(SCEA) were randomized to one of four groups: group E0 received patient-controlled epidural analgesia ( PCEA ) without LMWH; group EL sames but combined with LMWH; group I0 received patient-controlled intravenous analgesia (PCIA) without LMWH and IL the sames but combined with LMWH . Venous blood samples were taken after hospitalization, at the end of operation, 24 h, 48 h and 7 d after operation for determination of hameorheology, indexes of coagulation function. Visual analogue scale(VAS) scores were recorded at 24 h and 48 h postoperation. All the patients received colour Doppler ultrasonograhy examination before operation, and on the 7th day after operation. Complication of perioperation were recorded. Results There was no significant change in VAS among the four groups. The rates of DVT occurrence in group IL and EL were significantly lower than in group I0 and E0 ( P ＜ 0.05 ), and there was no significant difference between group IL and EL or between group I0 and E0. The incidence of nausea was markedly higher in group IL than that in group E0 and EL. Fib of all patients were significantly decreased at the end of operation and 24 h postoperation compared with base line values ( P ＜ 0.05 ), there was no significant difference each other in the four groups. Plasma viscosity and blood viscosity were lower in group E0 than in group I0 after operation (P ＜ 0.05 ), and lower in group IL and EL than in group E0 and group I0 after operation ( P ＜ 0.05 ). There was no significant difference in plasma viscosity and blood viscosity between group IL and EL. There was no significant change in PT and APTT in group I0 and E0 at all times, and no difference between the two groups.PT and APTT in group IL and EL were significantly prolonged at the end of operation and after operation compared with baseline values ( P ＜ 0.05 ), and prolonged compared with group I0 and E0 ( P ＜ 0.05). There was no difference in perioperation bleeding among all groups. Conclusion PCEA can improve hameorheology significantly compared with PCIA in patients undergoing THR without LMWH. Combined with LMWH perioperation, both PCEA and PCIA can reduce occurrence of venous thrombosis, improve coagulation function and hameorheology without increase of bleeding. Intraspinal anesthesia and PCEA are safe and feasible in patients received LMWH perioperation of THR. PCEA wasn't superior to PCIA in prophylaxis against postoperative venous thromboembolism when combined with LMWH.

Objective To understand the nature of subjective memory complaints through comparative study of depression status of patients with subjective memory complaints and mild cognitive impairment. Methods A total of 214 patients were assessed with the Center for Epidemiologic Studies Depression (CES-D) scale, the Geriatric Depression Scale and some neuropsychological tests. Among them, 76 were of subjective memory complaints (SMC), 74 amnestic mild cognitive impairment-single domain (aMCI-s) and 64 amnestic mild cognitive impairment-multiple domain (aMCI-m). Results According to CESD, 31% of the patients had symptoms of depression. The ratios were 30%, 24% and 39% in SMC,aMCI-s and aMCI-m groups respectively. GDS study showed that 43% of the patients had symptoms of depression. The ratios were 47%, 30% and 53% in SMC, aMCI-s and aMCI-m groups respectively. The ratio in SMC group fell between the other two groups. The total score of CESD ( 12 ± 10) or GDS ( 11 ± 6)of the SMC group, reflecting the severity of depression, fell between aMCI-s (CESD:1 1 ± 8, GDS :9 ± 5 )and ( CESD: 15 ± 11, GDS: 12 ± 7) groups. There was no significant difference between them in comparison with either aMCI-s or aMCI-m group ( P ＞ 0. 05 ). But the total score of CESD or GDS was significantly different between aMCI-m and aMCI-s groups ( P ＜ 0. 05 ). The depression status was worse in aMCI-m group than that in aMCI-s group. Conclusion There is no significant discrepancy in the incidence and severity of depression between SMC and aMCI groups. It indicates that depressive mood is not the specific cause of SMC.

Objective To investigate the relationship between the long-term outcomes of surgical treatment and preoperative pulmonary vascular resistance(PVR) or pulmonary to systemic flow ratio(Qp/Qs) in patients of congenital heart diseases with severe pulmonary hypertension (CHDSPH). Methods From February 1990 to July 2008, 1212cases of CHDSPH were treated non-surgically or surgically and were retrospectively classified as non-surgical group (n =297 ) and surgical group (n =915 ). Propensity score of inclusion into the surgical group were estimated and 245 trines were get with the same propensity score ±0. 05. The Kaplan-Meier survival curves were constructed for the 245 trines with the PVR stratum at the level of 120 kPa · L -1 · S-1 or with the Qp/Qs stratum at the level of 1.25. Results With the follow-up of 97 ±57 months, there were 44 late deaths in the surgical group and 65 late deaths in the non-surgical group. In the 245 propensity score matched trines, the Log rank test between non-surgical group and surgical group revealed x2 = 0. 54, P = 0. 4611 for the stratum of PVR ≥ 120 kPa · L- 1 · S- 1, and x2 = 51.68, P = 0. 000 for stratum of PVR ＜ 120 kPa · L-1 · S-1; the Log rank test between non-surgical group and surgical group revealed x2 = 0. 97, P = 0. 3254 for the stratum of Qp/Qs ＜ 1.25, and x2 = 62.77, P = 0. 000 for stratum of Qp/Qs ≥ 1.25. Conclusion for CHDSPH patients, the indication of the surgical closure should be defined as PVR ＜ 120 kPa · L-1 · S-1 and/or its Qp / Qs≥ 1.25.

Objective To analyze a potential association of gene polymorphisms of the folliclestimulating hormone receptor (FSHR) gene rs1394205 polymorphism and tyrosine hydroxylase (TH)rs2070762 polymorphism with pre-eclampsia. Methods The gene polymorphism of FSHR rs1394205 and TH rs2070762 were analyzed by real-time Quantitative polymerase chain reaction (TaqMan probe) in 105 patients with pre-eclampsia and 103 healthy pregnant subjects in Chinese Han population. Genotype and allele were assessed by direct counting methods. And the associations between 2 SNPs and pre-eclampsia were analyzed by chi-square test. Results The frequencies of the TH gene rs2070762 polymorphism CC, C/T and TT genotypes were 14. 6%, 42. 7% and 42. 7% in pre-eclampsia group and 18. 1%, 56. 2% and 25.7% in normal control group respectively. The allelic frequency of rs2070762 polymorphism in TH in preeclampsia patients was significantly lower ( P ＜ 0. 05 ) than that in normal pregnancies. There was a significant difference between two groups ( P ＜ 0. 05 ). But there was no significant difference between mild and severe pre-eclampsia groups ( P ＞ 0. 05 ). In contrast, no significant association was detected in the comparison of genotypes and allele of FSHR gene rs1394205 between pre-eclampsia patients and normal pregnancies. Conclusion The TH rs2070762 polymorphism was associated with the pathogenesis of preeclampsia. It suggests that the polymorphism in TH may be involved in the onset and development of preeclampsia.

Objective To investigate the characteristics of renal oxygenation status in aristolochic acids I (AA-I) induced ATN rat model by method of blood oxygenation level-dependent MRI (BOLD-MRI)and compare it with ATN model caused by gentamicin. Methods 28 male Wistar rats were randomly divided into control, AAN and GM groups, which were subcutaneously injected with normal saline, AA-I (25 mg· kg-1 · d- 1 ) or GM (200 mg · kg-1 · d- 1 ) respectively for 4 days. Intrarenal oxygenation was measured by BOLD-MRI at 4th day and 7th day. Renal histopathological changes and renal function were also observed at day 7. Results Serum level of creatinine and urinary NAG were obviously elevated at day 7 in AAN and gentamicin group. Diffuse tubular necrosis confined to the margin of renal cortex and medulla without edema or infiltration of inflammation cells was the main pathological finding in AAN group. BOLDMRI revealed that renal medullar R2* was elevated significantly at both day 4 [ ( 50. 6 ± 15.6 )/svs (35.6±4.3)/s, P＜0.01] and day 7[(58.4 ± 14.8)/s vs (37.8 ±3.6)/s, P＜0.01] in AAN group when compared to control, showing opposite changes to GM group whose R2* was decreased at the same time. In addition, the renal cortical R2 * in AAN group was also higher than that of control [ (40. 3 ± 14. 7 )/s vs (28.7 ± 3.2)/s, P ＜ 0. 05 ] at day 7, showing opposite changes to GM group. Conclusion Intrarenal hypoxia exists in acute AAN rats, which initiates in the medulla following an involvement in renal cortex. The phenomenon of persistent low level of intrarenal oxygenation is different from change of GM-induced ATN, which may contribute to the progression of renal interstitial fibrosis in AAN.

Objective To discuss the proliferous rule of bile duct endothelium after the placement of metallic biliary stent. Methods The metallic biliary stent was placed at the inferior segment of common bile duct of canine after a percutaneous transhepatic puncture at cholecyst. All the stented dogs were assigned randomly to 4 group including A、B、C and D, each group had been under research for 1 month, 3 months, 12 months and 24 months. The expression of PCNA and Ki-67 in bile duct endothelium covered by the stent were calculated on the immunohistochemistry staining images and compared with those uncovered in each group, then the expression of PCNA and Ki-67 in bile duct endothelium covered by the stent were compared between every two adjacent groups. The thickness of bile duct wall covered by the stent were measured on the HE staining images and compared between every two adjacent groups. The t-test was performed for the statistics. Results The animal model were successfully set in 18 canines. The expression of PCNA and Ki-67 in bile duct endothelium covered by the stent were significantly higher than those uncovered in every group ( P ＜ 0. 05 ), which got much high within 1 month after stenting ( P ＜ 0. 05 ) and gradually raised up again from 3 months to 1 year(P ＜0. 05) after a period of relatively low proliferation. The thickness of the bile duct covered by the stent changed following the same rule as well. Conclusion The metallic biliary stent indeed induced the proliferation of bile duct endothelium. This phenomenon enhanced gradually from 3 months to 1 year after stenting, and continued persistently after that.

With the social progress and the rapid development of modern medicine, the average life expectancy of the population in China is increasing year by year. The aging trend of the population is more and more concerned by the whole society. Dementia is a common disease in the elderly population, which is progressively developing, and there is no effective treatment at present.

Objective To evaluate the effect of depressing the press and the technical possibility of creating a percutaneous retroperitoneal splenorenal shunts (PRESS) by means of treating with swine with portal hypertension. Methods There were five normal microswine, all of which underwent portal vein embolization with polyvinyl alcohol (PVA) particles to creat the model of portal hypertension. After the successful creation of the model with portal hypertension, PRESS were placed to depress the portal venous press, placing covered-stents to connect the left renal vein and the splenic vein. The variance of relative venous press was observed. Splenic venogram was taked after the PRESS to observe the condition of blood flow in the vein and stents. Results Acute portal hypertension were created successfully in the five animals,then PRESS were placed . One animal died during the opertaion(died of overdose of anesthesia),stent placement were successfully completed in the other four animals. The splenic venogram revealed good flow from the splenic vein to the left renal vein through the shunt track. After the PRESS, the portal venous and the splenic press press descended, and the left renal press elevated. Conclusion Creation of a PRESS for swine with portal hypertension is technically possible, and further experimental studies of its safety are warranted.

A 42-year-old male was admitted to hospital for more than 1 month due to right middle and upper abdominal pain. Physical examination showed mild tenderness in right middle and upper abdomen without rebound pain. Laboratory examination showed normal blood routine, sugar chain antigen: 0.577 million U/L, carcinoembryonic antigen: 1.59 μ g/L, blood amylase: 169 U/L, urine amylase: 761 U/L. Endoscopic examination showed that the mucosa of the duodenal bulb was bulged, with irregular surface, obvious congestion and swelling, and descending segment stenosis, suggesting duodenal mass.