Volume 93  ·   Issue 09  ·  2013

To explore the clinical efficacies of endovascular therapy for traumatic arterial intima injury, arterial pseudoaneurysm and arteriovenous fistula.

From October 2009 to December 2011, 24 patients of arterial intima injury, arterial pseudoaneurysm and arteriovenous fistula underwent endovascular therapy including embolism and stent implantation, etc.

Among them, 14 patients were punctured directly and another 10 were punctured after the exposure of arteries.The interventions included embolism (n=3), embolism plus covered stent implantation (n=2), covered stent implantation (n=12) and bare stent implantation (n=7).And the surgical success rate was 100%.After endoluminal treatment, arterial blood flow recovered, arterial pseudoaneurysm shrank, local pain relieved and venous blood pressure decreased.

As an effective therapy for traumatic arterial intima injury, arterial pseudoaneurysm and arteriovenous fistula, endovascular therapy has minimal trauma, fewer complications and satisfactory outcomes.

To explore the treatment and prognosis of critical limb ischemia during perioperative period of open surgery for ruptured abdominal aortic aneurysm (AAA).

Retrospective reviews were conducted for the clinical data of unstable ruptured AAA patients with open repair at our hospital from June 2002 to June 2012 to examine the characteristics and treatment regimens for associated critical limb ischemia.

A total of 46 unstable AAAs were enrolled.There were 37 males and 9 females with an average age of 69 years.All AA As were repaired by a bifurcated polytetrafluoroethylene graft via a transperitoneal midline incision.Critical limb ischemia was found in 8 patients during or after the procedure.Treatments included additional graft-distal iliac artery bypass (n=2), anastomotic stoma stenting (n=2), Fogarty catheter embolectomy plus local thrombolysis (n=2), Fogarty catheter embolectomy (n=1) and venous thrombolysis (n=1).Lower limb necrosis developed in 5 patients (4 unilateral,1 bilateral) and all of them died.

Open repair of ruptured AAA may be associated with a considerate morbidity of critical limb ischemia.Early reconstruction of blood flow improves the prognosis.

To summarize the clinical performances and analyze the morphological characters of acute Stanford B aortic intramural hematoma (IMH) on computed tomography (CT).

From January 2010 to June 2012, a total of 28 IMH patients at General Hospital of People′s Liberation Army were retrospectively reviewed.Among them, 18 patients were followed up with CT.The data of vessel wall maximum thickness (MT),aortic maximum outside diameter (OD) and aortic inner diameter (ID) at onset and 1 week, 1, 3, 6, 12 months post-onset.Statistical analysis was performed with paired t-test.

No mortality occurred.Two patients received endovascular repair.According to the follow-ups of 18 IMH patients, MT was (12.1±2.6) mm on CT.Hematoma disappeared in 44.4% patients at 6 months post-onset.Hematoma disappeared more in the patients with MT≤10 mm than those with>10 mm (85.7% vs 18.2%, P<0.01).Hematoma disappeared in 13/15 patients (86.7%) at 12 months post-onset.OD decreased (7.3±2.4) mm per year and (6.7±3.5) and (0.6±1.7) mm within the first 6 months and 6 months later respectively.OD increased (0.9±0.5) mm after the disappearance of hematoma.ID increased (6.1±2.3) mm per year and (4.7±1.8) and (1.2±1.0) mm within the first 6 months and 6 months later respectively.

The early and midterm outcomes of IHM are satisfactory most of hematoma disappear 12 months after onset.Hematoma disappears more rapidly in the patients with MT≤10 mm than those with>10 mm.OD reduces and ID increases before the disappearance of hematoma,and both increase afterward.Aortic cavity has a trend of dilating continually.

To compare the efficacy, cost and safety of endovascular aortic repair (EVAR) versus open surgery in the treatment of infrarenal abdominal aortic aneurysms.

Retrospective analyses were conducted for the clinical data and follow-up information of 218 cases from January 2002 to December 2011 at our hospital.Open surgery group included 86 patients with an mean age of 65.5 years and a mean aneurysm diameter of 5.4 cm.In EVAR group, there were 132 cases with an average age of 76.8 years and a mean aneurysm diameter of 5.6 cm.

Among 86 open cases, there were inverted"Y"type artificial graft (n=83) and straight artificial graft (n=3).The surgical success rate was 98.8%, perioperative period mortality rate was 2.3%, a mean volume of blood loss 450 ml and a mean transfusion volume 320 ml.The mean operative duration was 230 min, a mean hospitalization time (30±3) days and a mean hospitalization cost RMB yuan 58 000.In EVAR group, the surgical success rate was 100% and perioperative period mortality rate 0.8%.Separating stent graft (n=121,91.7%), straight stent graft (n=4,3%) and one-stent-graft (n=7, 5.3%).The mean operative duration was 150 min, a mean volume of blood loss 140 ml, a mean hospitalization time 15.5 days and a mean hospitalization cost RMB yuan 104 800.The operative duration, volume of blood loss and length of hospital stay of EVAR group were superior to those of open surgery group (P<0.05).But the cost of group EVAR was significantly higher than that of group open surgery (P<0.05).In group open surgery,80 cases (94.1%) received a mean follow-up period of 46 months.And 79 artificial grafts maintained patency (98.8%) and 8 cases died (10%).There were 125 cases in group EVAR (94.7%) with a mean time of 32.5 months| stent graft patency in 120 cases (96%),10 death|8 complication cases (5.6%) involved stent migration (n=2) and iliac artery branch occlusion (n=6).Long-term effects had no significant difference between two groups (P>0.05).In terms of the incidence of complications, group EVAR was significantly more than group open surgery (P<0.05).

In terms of operative duration, volume of blood loss and length of hospital stay, EVAR and open surgery treatment for infrarenal abdominal aortic aneurysms group EVAR is significantly better than group open surgery.As far hospitalization cost, group EVAR is significantly higher than group open surgery.But, in terms of incidence of long-term complications, group EVAR is significantly higher than group open surgery while the latter often requires further interventions.

To explore the imaging reasons for periprosthetic femoral fractures during the operation of total hip arthroplasty with anatomic prosthesis.

The fracture group consisted of 7 cases with periprosthetic femoral fracture (PPFF) and the non-fracture group 21 cases without PPFF during the operation of total hip arthoplasty (THA) among the 144 cases of primary THA with anatomic prosthesis.The preoperative plain films of hip joint were taken to calibrate the Sharp′s angle, centre edge (CE) angle, femoral neck shaft angle, femoral anteversion angle of neck, bowing angle of proximal femoral shaft part, width of narrowest part in proximal femoral shaft.For each case, surgical details, age, height and weight were recorded.The results were analyzed with independent sample t test by software SPSS 17.0.

No significant difference existed in general situation,Sharp′s angle and CE′s angle between two groups.And there were significant differences in femoral neck shaft angle (P=0.040), femoral anteversion angle of neck (P=0.026), bowing angle of proximal femoral shaft part (P=0.024), width of narrowest part in proximal femoral shaft (P=0.021).

Dysplasia of proximal femur is a major cause of periprosthetic femoral fracture during the operation of total hip arthroplasty with anatomic prosthesis.

To explore the effects of diagnostic protocols on etiology and outcome in immunocompromised host (ICH) with pulmonary infiltrate.

For this historic control study, ICH with acute respiratory failure (ARF) were eligible as study group (n=65) in 2009 while another ICH cohort was selected as control group (n=45) in 2007.The protocol consisted of four parts: judgment possible site, determining probable etiology, checking and feedbacks on laboratory test in 12 hours and reassessment and adjustment treatment in 48- 72 hours.The etiologies included infection, noninfection and unknown causes.

Their average age was 45.3 years (range: 22- 71).Causes of immune suppression were autoimmune disease (n=69), hematological disorders (n=21), solid cancers (n=10) and others (n=10).When two groups were compared, basic diseases, organ function and disease severity showed no significant difference, but etiologic diagnoses rate (73.8% vs 57.8%), time from ICU admission to diagnosis (4.0 vs 6.8 days) and 28-day mortality (38.5% vs 62.2%) had significant difference (P<0.05).

Implementation of clinical protocol in ICH with ARF is associated with improved etiologic diagnoses and decreased mortality.

To investigate the ability of decision making under ambiguity condition in epileptics.

Twenty-five epileptics (EP) at our hospital during June 2011 to March 2012 and 25 healthy controls (HC) were surveyed by Iowa Gambling Task (IGT) with ambiguous probability.Statistical analyses were performed with analysis of variance (ANOVA) and independent sample t test.And α=0.05 denoted the level of significant differences.

As compared with HC, the epileptics were impaired in decision-making under ambiguity and scored lower in IGT (EP:- 4.56±10.26| HC:4.32±24.14| t=- 2.23, P=0.029).A comparison between the scores of subjects on 5 blocks suggested: HC subjects scored higher on block 3 (HC:2.40±7.07| EP:- 1.44±3.98) and block 5 (HC:4.00±7.46| EP:0.00±4.51) than the scores of EP subjects (block 3, F=3.950, P=0.022, block 5, F=6.416, P=0.027).

The EP patients have significant impairment in decision-making under ambiguity.

To explore the ecological executive function profile in depression patients before and after antidepressants treatment and analyze the relationship of ecological executive function and depression symptoms and effect.

A total of 33 inpatients diagnosed as depression disorder according to ICD-10 completed the Behavior Rating Inventory of Executive Function-Adult Version (BRIEF-A) and Hamilton Depression Scale (HAMD) before and after a 6-week antidepressant treatment.

(1) After treatment, they yielded lower scores significantly on most subscales of BRIEF-A (t=2.061-4.229, P<0.05), including total score[(127±27) vs (113±28)], shifting[(11.7±2.7) vs (10.3±2.6)], emotion control[(18.8±4.6) vs (15.8±4.4)], monitoring[(9.6±3.0) vs (8.8±2.7)], initiation[(15.6±3.7) vs (13.2±3.6)], working memory[(14.9±3.4) vs (13.3±3.9)], planning[(18.3±4.4) vs (16.6±4.4)], organization[(12.4±3.8) vs (11.4±3.1)], behavioral regulation index (BRI), metacognition index (MI) and global executive composite (GEC). (2) Before treatment, Person′s correlation test showed that the total score of HAMD and all subscales of BRIEF-A had no significant correlation respectively (r=-0.145-0.220, P>0.05). (3) After treatment, the deduction of total score of HAMD and the deduction of the scores of inhibiting belonging to behavioral regulation index (BRI) and initiation, planning belonging to metacognition index (MI) had moderate correlations respectively (r=0.450, 0.432, 0.403, P<0.05). (4) Multiple regression analysis showed that the scores of working memory, organization and the deduction of total score of HAMD had significantly negative correlations respectively (t=-2.295,-2.488, P<0.05).

The antidepressant treatment can improve ecological executive function of depression patients. And the improvements of ecological executive function and depression symptoms are partially correlated.

To explore the feasibility and efficacy of supraorbital keyhole approach (SOKA) for the clipping of distal basilar artery (BA) aneurysms.

A total of 12 patients with distal BA aneurysms were treated with SOKA.All patients had subarachnoid hemorrhage (SAH).They underwent surgeries for an average of 7.6 days post-SAH (n=2, within 24 hours|n=7, 3-14 days| n=2, 2 week later).Aneurysms were located on BA (n=10), posterior cerebral artery (PCA) 1-2 segment (n=1) and PCA 2 segment (n=1).One-stage operations were performed in 2 cases with BA bifurcation aneurysm accompanied with anterior cerebral artery (ACA) 1 segment aneurysm and multiple middle cerebral artery (MCA) aneurysms respectively.Anterior and posterior clinoid process was drilled off in 2 patients respectively to increase the room for maneuver.Posterior communicating artery was cut in one case to expand the working space.Once a balloon catheter was put into BA, proximal artery control was implemented if immature aneurysm rupture occurred.

All distal BA aneurysms were completely clipped| 3 accompanied aneurysms were clipped together through single supraorbital keyhole approach.One aneurysm ruptured intra-operatively and was clipped successfully with temporary parent arterial occlusion.No conscious disturbance and dyskinesia occurred post-operatively for all patients.

During the procedure of SOKA, anterior and posterior clinoidectomy may be applied to increase the working space.Distal BA aneurysms located less than 15 mm higher over anterior skull base can be effectively treated via SOKA.

To retrospectively explore the long-term efficacies of sinus skeletonization plus abnormal venous reflux interruption in the treatment of dural arteriovenous fistula interfering major dural sinus.

Among 15 consecutively treated patients, the lesions were located in superior sagittal sinus (n=7), medial segment of transverse sinus (n=3) and lateral transverse and sigmoid sinus (n=5).And 40% of them clinically presented with intracranial hypertension and 13.3% with hemorrhage.Preoperatively, Gamma knife therapy and transarterial occlusion were used in 1 case each.All underwent sinus skeletonization plus abnormal venous reflux interruption if any.Interfered sinus was preserved in 12 cases.In another 3 cases, completely occluded segment of sinus was resected after skeletonization.

Surgical mortality was none.At discharge, the symptoms were relieved or disappeared in 12 cases.Follow-up study was available in 11 cases over a mean period of 6 years.A Karnofsky performance status (KPS) score of 90 or more was achieved in 8 cases and a KPS score of 80, 60 or 40 was found in 1 case each.Digital subtract angiography was performed in 9 cases and computed tomographic angiography in 1 case after operation.Cure was achieved in 7 cases and 3 cases had minimal residue without recurrence.

Sinus skeletonization may stably block most blood supply to fistula so as to offer cure or long-term control of dural arteriovenous fistula.

To explore the efficacy and safety of transcatheter arterial chemoembolization (TACE) plus sorafenib in the treatment of advanced hepatocellular carcinoma with different types of portal vein tumor thrombosis.

A total of 32 patients of advanced hepatocellular carcinoma with tumor thrombosis in portal vein were retrospectively analyzed.All of them took oral sorafenib after TACE.They were divided into 3 groups according to imaging examinations of tumor thrombosis in portal vein.Tumor thrombosis in main portal vein was group A, tumor thrombosis in right/left portal branch group B and tumor thrombosis in the second branch of portal vein group C.Tumor response rate,disease control rate (DCR), overall survival (OS) and time to tumor progression (TTP) was followed up.Liver functions were compared with the pre-treatment level.The occurrences of adverse events were recorded.

DCR was 20.0% (Group A),70.0% (Group B) and 91.7% (Group C) at 2 months post-treatment.DCR in groups B and C had significant differences with group A (P<0.05).The median OS was 3 (Group A), 9 (Group B) and 14 months (Group C) and the median TTP 0 (Group A), 3 (Group B) and 6 months (Group C) respectively.The median OS and median TTP were significantly longer in Groups B and C than those in Group A (P<0.05).Liver function at 2 months post-treatment had no statistical difference with the baseline.The most common adverse effects included hand foot skin reaction (n=23, 3 cases of grade 3),hypertension (n=3), diarrhea (n=25, 3 cases of grade 3), hair loss (n=12), oral ulcers (n=1) and gastrointestinal bleeding (n=2).

The combined use of TACE and sorafenib is both safe and efficacious in the treatment of advanced hepatocellular carcinoma with tumor thrombosis in portal vein.And it may prolong OS and TTP in hepatocellular carcinoma with tumor thrombosis in right/left portal vein and second branch of portal vein.

To explore the expression and role of glucose-regulated protein 78 in ovarian serous adenocarcinoma.

The surgical specimens were collected from 126 cases of serous ovarian tumors and 30 cases of normal ovarian tissue.And the mRNA and protein expressions of GRP78 were detected by immunohistochemistry, reverse transcription-polymerase chain reaction (RT-PCR) and Western blot.

The results of immunohistochemistry showed that GRP78 positive cells in ovarian serous adenocarcinoma were significantly higher than those in normal ovarian and ovarian serous cystadenoma tissues (P<0.05).In ovarian serous adenocarcinoma, GRP78 expression was not associated with pathological grade, age and clinical staging (P>0.05).And the mRNA expressions of GRP78 in normal ovarian tissue,ovarian serous cystadenoma and ovarian serous cystadenocarcinoma were 0.134±0.021, 0.121±0.032 and 0.685±0.085 respectively.Protein expressions of GRP78 in normal ovarian tissue, ovarian serous cystadenoma and ovarian serous cystadenocarcinoma were 0.211±0.042, 0.193±0.032 and 0.770±0.074 respectively.GRP78 mRNA and protein expression had no difference between different pathological grades of ovarian serous cystadenocarcinoma (P>0.05).

GRP78 is highly expressed in ovarian serous adenocarcinoma.And its differential expression between ovarian benign and malignant tumors is significant and correlated with the occurrence and progression of ovarian cancer.

To explore the effects of blood, crystalloid and colloid on mesenteric microcirculation in rabbits of acute hemorrhagic shock.

Hemorrhagic shock was induced in 28 anesthetized mechanically ventilated rabbits by withdrawing blood to a mean arterial blood pressure (MAP) of 40 mm Hg and maintained for 30 min.The animals were randomized into blank control group, whole blood resuscitation group, Ringer′s solution resuscitation (RR) group and volume resuscitation (VR) group (n=7 each).The data of vital signs, systemic hemodynamic parameters, arterial blood gas analysis and mesenteric microcirculation were collected at baseline,hemorrhagic shock (HS-0), resuscitation 0 min (Res-0) and resuscitation 30 min (Res-30).And side-stream dark field imaging (SDF) was employed to acquire the images of mesenteric microcirculation.

No significant difference existed in the basic status between 4 groups.MAP decreased to around 40 mm Hg in all groups.MAP increased significantly after active fluid resuscitation (P<0.05).In addition to blank control group, total vascular density (TVD), perfused vessel density (PVD), proportion of perfused vessels (PPV) and microvascular flow index (MFI) significantly increased after active fluid resuscitation in the other three groups.TVD and PVD were significantly lower at Res-0 in VR than in RR (P<0.05).

After acute hemorrhagic shock, fluid resuscitation with whole blood and Ringer′s solution improves systemic hemodynamics.And the combined regimen of whole blood and Ringer′s solution is better at restoring mesenteric microcirculation.

To preliminary observe the feasibility and safety of bipolar radiofrequency ablation catheter in the treatment of malignant biliary obstructive jaundice and biliary stent restenosis.

Four patients with malignant obstructive jaundice caused by terminal cancer received ablation therapy for biliary obstruction by percutaneous transhepatic bipolar radiofrequency ablation catheter.The normal tunnel of biliary was reconstructed rapidly to restore the outflow tract of bile.The procedural practicality, clinical safety and operative complications were analyzed.

The ablation therapy was successful for 4 patients.The mean operating duration was 40 min without any 30-day mortality.No postoperative complications such as massive hemorrhage, biliary fistula, biliary infection, hemothorax, pneumothorax, cholothorax, chole-heart syndrome, liver penetrating wound and biliary peritonitis etc.occurred.Cholangiectasis improved markedly after biliary tract reconstruction with general declines of serum total bilirubin and direct bilirubin.One case with biliary stent re-stenosis was re-blocked postoperatively.The average patency time of biliary tract and stent was 124 (90- 171) days in 4 cases.Conditions were created for further anti-tumor treatment.

Percutaneous transhepatic bipolar radiofrequency ablation catheter can reestablish the canal rapidly for malignant biliary obstructive jaundice and stent re-stenosis so as to enhance the therapeutic efficacy.