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Objective:To explore the efficacy of percutaneous osteoplasty (POP) combined with 131I therapy in patients with bone metastases from differentiated thyroid carcinoma (DTC) and assess the survival. Methods:From Januray 2008 to January 2020, 29 DTC patients with bone metastases (16 males, 13 females, age range: 24-64 years) who received POP combined with 131I therapy in Shanghai Sixth People′s Hospital were retrospectively analyzed. Clinical data and characteristics of patients were analyzed. The efficacy and prognosis were evaluated based on the changes of serum thyroglobulin (Tg) and relieving condition of bone pain after the combined treatment. χ2 test was used to determine the association between clinical characteristics and efficacy, and Kaplan-Meier analysis was used to estimate the overall survival (OS) rate. Results:The biochemical response rate of serum Tg was 68.97% (20/29) after the combined treatment. For the influence on changes of serum Tg, whether or not combined with non-osseous distant metastasis, and cumulative dose of 131I treatment(≥22.2 vs <22.2 GBq) were statistically significant ( χ2 values: 5.448 and 4.371, both P<0.05). The rate of bone pain relief was 65.52%(19/29). Age (≥55 vs <55 years) and the cumulative dose of 131I treatment had statistically influences on bone relief ( χ2 values: 7.486 and 5.154, both P<0.05). The 5-years OS rate of patients was 87.68%, while the 10-years OS rate was 65.76%. Conclusion:POP combined with 131I therapy is effective on relieving the pain, reducing the serum Tg to some extent, and improving the long-term survival of DTC patients with bone metastasis.
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Percutaneous vertebroplasty (PVP) is a minimally-invasive technique,which has been widely employed in the treatment of hemangiomas,vertebral compression fractures,spinal metastases,myeloma and other diseases.Clinically,it is generally believed that the curative effect of PVP is closely related to the injected amount of bone cement.However,there is still great controversy over the optimal injection volume of bone cement.Based on the current researches both at home and abroad,this article aims to make a brief introduction about the relevant vertebral biomechanical factors that might affect the injection volume of bone cement,the influence of the injected volume of bone cement on the vertebral strength,rigidity and adjacent vertebral bodies.The main current disputes are pointed out so as to lay the foundation for further study.
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Objective To discuss different performance of DR and CT examination on secondary pulmonary tuberculosis,to improve the clinical guidance value of CT in the diagnosis of secondary pulmonary tuberculosis. Methods The image data of 52 cases with secondary pulmonary tuberculosis confirmed by pathology were collected, including chest DR radiography and CT scans.The different image characteristics of two kinds of imaging examination were analyzed and compared.Results In 52 cases of secondary pulmonary tuberculosis,chest X -ray plain film found lesions calcification in 3 cases,2 cases of bronchiectasis,pleural thickening and adhesion in 12 cases,pleural effusion in 1 case,empty cavity in 4 cases,emphysema in 1 case,the lung nodules in 5 cases.Chest CT revealed lesions calcification in 9 cases,16 cases of bronchiectasis,pleural thickening and adhesion in 40 cases,pleural effu-sion in 4 cases,empty cavity in 10 cases,emphysema in 8 cases,the lung nodules in 10 cases,6 cases of pulmonary bullae,pulmonary interstitial change:4 cases of lung reticulocyte shadows,interlobular septal thickening in 4 cases, ground glass sample density in 4 cases.Conclusion DR and CT can be used for inspection of secondary pulmonary tuberculosis,but CT is a better tool,it has important guiding role for clinical diagnosis and treatment.
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Objective To assess the clinical value of percutaneous bone cement fusion in treating stress fracture of vertebral body that is adjacent to pseudoarthrosis in patients with ankylosing spondylitis.Methods The clinical data of 4 ankylosing spondylitis patients with stress fracture of vertebral body adjacent to pseudoarthrosis,which was treated with percutaneous bone cement fusion,were retrospectively analyzed.Bone cement fusion through injection of bone cement was performed for 4 vertebral segments.Visual analogue scale (VAS) of pain and Oswesty disability index (ODI) were determined before and after operation,the results were compared,and the improvements of pain and daily activity were evaluated.Results The operation was successfully accomplished in all the 4 patients.The mean used amount of bone cement for each vertebral segment was 14.5 ml.Small amount of bone cement extravasation was observed in one patient,but no severe clinical complication occurred.The mean VAS score decreased from preoperative 9 points to postoperative 3.5 points;ODI score decreased from preoperative 43.8 points to postoperative 14.5 points.After the treatment,the pain was obviously relieved and the daily activity was markedly improved.Conclusion For the treatment of stress fracture of vertebral body that is adjacent to pseudoarthrosis in patients with ankylosing spondylitis,percutaneous bone cement fusion is minimally-invasive,safe and effective.
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Objective To investigate the relationship between the cystic fluid characteristics of symptomatic sacral canal cyst and the interventional therapeutic prognosis.Methods A total of 114 patients with symptomatic sacral canal cyst were enrolled in this study.Clinically,all patients complained of discomfort at lumbosacral area.Among the 114 patients,86 were primary sacral canal cyst and 28 were recurrent sacral canal cyst.Under DSA guidance,percutaneous puncturing of the cyst was performed,2-5 ml cerebrospinal fluid (CSF) was aspirated and sent for laboratory tests.Then a small amount of nonionic contrast agent was injected into the cyst to determine whether the cyst was communicated with the subarachnoid space or not.Finally,double-needle method was used to aspirate the cyst fluid.Results Radiography showed that communication between the cyst and subarachnoid space was detected in 66 patients (group A),while no communication between the cyst and subarachnoid space was observed in 48 patients (group B).In patients with primary symptomatic sacral canal cyst,the differences in the sugar and chloride levels of CSF between group A and group B were statistically significant.In patients with recurrent symptomatic sacral canal cyst,the differences in the sugar,protein and chloride levels of CSF between group A and group B were also statistically significant.Statistically significant correlation existed between the single or multiple CSF changes and the interventional therapeutic prognosis.Conclusion Sacral canal cysts can be classified into two types:cyst-subarachnoid space communicating type and cyst-subarachnoid space non-communicating type.The characteristics of CSF in patients with primary symptomatic sacral canal cyst are different from those in patients with recurrent symptomatic sacral canal cyst.Multiple CSF changes,the increased sugar level and decreased chloride level in CSF are well correlated with the interventional therapeutic prognosis.
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Along with the aging of population in China,more and more people suffer from osteoporosis.As a consequence,osteoporotic vertebral compression fracture has become one of the major clinical issues.More and more patients like to take percutaneous vertebroplasty (PVP) as the preferred treatment,thus,the number of patients who develop recurrent vertebral fracture after PVP is also increased.In recent years,more and more attention has been paid to the recurrent fractures after PVP for vertebral compression fractures by clinicians.In order to reduce the incidence of recurrent vertebral fracture after PVP,it is necessary to make the further and deep studies on the risk factors that cause recurrent vertebral fractures.This paper aims to make a comprehensive review about the risk factors that may cause recurrent vertebral fractures after PVP for osteoporotic vertebral compression fracture.
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Objective To analyze the magnetic resonance imaging (MRI)and histologic features of the synchronous bilateral primary breast cancer (sBPBC).Methods MRI findings and pathologic types of sBPBC in 20 patients in our institute were reviewed retrospectively. The MRI features of sBPBC were compared with the pathologic types,respectively.Results 20 sBPBC patients with 41 lesions were found with the most common pathological type of invasive ductal carcinoma in 26 (26/41 ).Bilateral lesions had the same pathological types in 1 1 patients(1 1/20),and different types in 9(9/20).The MRI features of invasive breast cancer were more characteristic than that of early breast cancer.In 20 patients,the first and second primary breast cancers with similar MRI findings were found in 6(6/20).In 10 patients with sBPBC,the first cancer was advanced breast cancer,and the second was early or low grade breast cancer.Conclusion (1)The most common pathological type of sBPBC is invasive ductal carcinoma,and the pathological types of bilateral lesions are not similar. (2)The MRI features of the first and the second lesions in bilateral primary breast cancer showed lower similarity,and the bilateral lesions should be diagnosed independently.(3)In patients with sBPBC,some cancers are advanced breast cancers,and the second ones are early cancers,suggesting the lesion should be followed up if the contralateral one is diagnosed as breast cancer.
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BACKGROUND:Percutaneous vertebraplasty is a new means for the treatment of vertebral compression fractures and bone metastases. The multiplaner reconstruction with digital substraction angiography (DSA)-Innova 3D plays an important role in guiding the percutaneous vertebraplasty puncture, which can effectively prevent the leakage of bone cement. OBJECTIVE:To explore the value of DSA-Innova 3D in the guidance of puncture of percutaneous vertebroplasty. METHODS:From March 2014 to September 2014, a total of 72 patients with 94 vertebras were selected for percutaneous vertebraplasty, of whom 36 (48 vertebras) with Innova 3D (experimentalgroup) and 36 (46 vertebras) without Innova 3D (control group). Spiral CT scan was performed in al patients to assess the distribution of bone cement. The imaging quality in the two groups was compared by Mann-Whitney U test. RESULTS AND CONCLUSION:CT showed bone cement leakage occurred in 7 of the 36 patients in the control group. Leakages were into the lumber disc in two cases, paravertebral space in two cases, vertebral pedicle in onecase or veins in two cases. However, only one case of bone cement leakage was observed in the experimental group. With the guidance of DSA-Innova 3D, the experimental group had signficantly lower leakage and fluoroscopic time than the control group (P < 0.05). The multiplaner reconstruction with DSA-Innova 3D plays an important role in guiding the percutaneous vertebraplasty puncture, thereby effectively reducing the leakage of bone cement.
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Objective To discuss the clinical value of percutaneous vertebroplasty (PVP) in treating severe vertebral compression fracture. Methods During the period from June 2012 to March 2013, PVP was carried out in 30 patients with severe vertebral compression fracture (30 diseased vertebrae in total). The clinical data were respectively analyzed. According to the shape of compressed vertebra , the fractures were divided into three types: wedge-shaped, double concave and oblong-shaped. For wedge-shaped fracture, PVP was performed via the pedicle access of the healthy side. For double concave type , unilateral pedicle access was used, while for oblong-shaped type unilateral or bilateral access was adopted to conduct PVP according to the distribution of the injected PMMA. The therapeutic results were evaluated by using VAS and pain degree classification standard of WHO. The preoperative and postoperative vertebral height was estimated on the lateral projection. All patients were followed up for six months at out-patient clinic or by telephone. Results The success rate of puncturing was 100%. The preoperative mean VAS was 6.9 ± 0.9. The postoperative VAS at one day, one, 3 and 6 months after the procedure was 5.0 ± 0.9, 3.5 ± 0.7, 2.5 ± 0.8 and 1.6 ± 0.7 respectively. Based on WHO pain degree classification standard, complete remission (CR) was obtained in 25 cases, partial remission (PR) in 3 cases, and invalid in 2 cases. The effective rate (CR +PR) was 93.33%. The mean preoperative height of the compressed vertebrae was (5.77 ± 1.09) mm and the mean postoperative height of the compressed vertebrae was (14.33 ± 2.03) mm. Conclusion For the treatment of severe vertebral compression fractures, percutaneous vertebroplasty is clinically feasible with reliable short-term effect.
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Objective To discuss the feasibility and clinical application of percutaneous internal fixation (PIF) combined with pecutaneous osteoplasty (POP) for the treatment of metastasis of proximal femur with impending pathological fracture. Methods Six consecutive patients with metastases of the proximal femur, who could not be able to tolerate conventional surgery, underwent PIF together with POP. The results were analyzed. Results The procedure was successfully accomplished in all six patients. Neither pulmonary embolism nor death occurred in all patients during and after the operation. No fracture at operated area was observed during follow-up period. Conclusion For stabilization of proximal femoral metastatic lesion with impending pathological fracture, percutaneous internal fixation combined with pecutaneous osteoplasty is a safe and effective technique.
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Objective To discuss the feasibility and short-term clinical effectiveness of DSA-guided percutaneous vertebroplasty (PVP) for the treatment of painful osteoblastic metastatic spinal lesions. Methods During the period from Jan. 2010 to Dec. 2011 at authors’ hospital PVP was carried out in 23 patients with osteoblastic spinal metastases (34 lesions in total). Coexisting osteoblastic pathological fracture was found in twelve patients. The WHO standards, visual analogue scale (VAS) and karnofsky-KPS score were used to evaluate the therapeutic results. Results Technical success was achieved in all patients. All patients were followed up for at least 3 months. Of 20 patients who had complete clinical data, complete remission (CR) was obtained in 6, partial remission (PR) in 10, mild remission (MR) in 3 and no remission (NR) in one. The clinical effectiveness (CR+PR) was 80%. The mean VAS scores dropped from preoperative (7.0 ± 1.6) to (2.2 ± 1.9) at 24 hours after the treatment, and to (2.4 ± 2.1) and (2.5 ± 2.1) at one and three months after the treatment respectively. The mean KPS scores rose from preoperative (76.5 ± 10.4) to (86.5 ± 11.8), (88.0 ± 12.0) and (89.0 ± 10.8) at 24 hours and one, three months after the treatment respectively. Small amount leakage of PMMA was observed in 4 cases (17.4%) with no obvious clinical symptoms. Conclusion DSA-guided PVP is a feasible and effective treatment for painful osteoblastic spinal metastases. This therapy can immediately relieve pain and reinforce spine, besides, it can remarkably improve the living quality and decrease the incidence of paraplegia.
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BACKGROUND: Bone cementoplasty can elevate the life quality of patients by instant alleviating pain and stable fracture. However, the effects of bone cementoplasty should be further analyzed due to it is lack of long-term follow-up and clinical practices.OBJECTIVE: To retrospectively analyze the therapeutic effect of bone cementoplasty accompanied by radiotherapy for malignant tumor patients with bone metastaese.METHODS: Totally 60 malignant tumor patients with bone metastaese treated in Shanghai Sixth Peoples' Hospital from September 2006 to February 2009 were randomly divided into 2 group, with 30 cases in each group. In the radiotherapy group, patients were exposed to 6 MV X-ray, 2 Gy once, 5 times per week, for 4 successive weeks. In the combination group, patients were underwent bone cementoplasty accompanied by radiotherapy. The combination of verbal rating scale (VRS) and visual analogue scale (VAS) were used to assess bone pain. The onset times of two groups were compared. RESULTS AND CONCLUSION: The scores of bone pain were similar between before and after treatment (P > 0.05). Compared with the radiotherapy group, the bone pain of combination group was significantly relieved after treatment (P<0.05). There were 13 patients were ineffective to treatment in the radiotherapy group, which was 8 patients in the combination group. In addition, the onset time of radiotherapy group was later than that of the combination group. In the 10-month follow-up, 25 patients in the radiotherapy group and 21 patients in the combination group were dead. The survival patients of combination group were greater that those of radiotherapy group. No evidence showed that the death was correlated to bone cement, namely, bone cementoplasty accompanied by radiotherapy can be more effective in the treatment of bone metastases than simple radiotherapy,and it might be the first choice in clinical practice.Huang YF, Fu S, Wu CG.Bone cementoplasty accompanied by radiotherapy for malignant tumor patients with bone metastaese:
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Objective To discuss the technical points, safety and clinical effectiveness of DSA-guided percutaneous acetabuloplasty (PA) for the treatment of acetabular metastases. Methods Fifteen patients, including 6 males and 9 females, with acetabular malignant metastases were enrolled in this study.A total of 19 lesions were detected. The lesions were 13 - 25 mm in size (mean 19 ± 4 mm), the dose of PMMA used for per lesion was 5 - 13 ml (mean 8.2 ± 2.3 ml). All patients complained of greater or less degree of pain in their hips, 8 patients had to use walking stick, 4 patients showed limping although they could walk independently and three patients could not walk alone. DSA-guided percutaneous acetabuloplasty was performed in all patients and follow-up after the procedure was conducted for 1 - 12 months. Visual analogue score (VAS), walking state score and analgesic dosage taken by the patients were used for the evaluation of the clinical effectiveness. The complications were analyzed. All the data obtained were statistically analyzed with paired samples t test and analysis of variance by using SPSS12.0 statistical software.Results The procedure was technically successful in all patients. Pain rating evaluated by the VAS decreased from a mean of 7.8 before surgery to a mean of 4.2 in 24 hours after surgery (P < 0.01 ), which further decreased to 2.5 in one month (P < 0.01 ), while walking state score increased from a mean of 1.5before surgery to a mean of 2.5 in 24 hours after surgery (P < 0.01 ). The analgesic dosage taken by the patient was reduced in 14 patients and remained the same in one patient. The bone cement leakage into paraacetabular soft tissues occurred in three cases and peripheral vascular exudation of acetabulum was observed in three cases with no obvious clinical symptoms. Conclusion As a safe, reliable and minimally-invasive technique, DSA-guided percutaneous acetabuloplasty has excellent anti-pain effect in treating acetabular metastases. This therapy can markedlyimprove the patient's walking ability and the quality of life.
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To prepare scaffolds for heart valve tissue engineering, porcine heart valves were treated with varied concentrations of trypsin for 32, 56, 80 and 104 h or followed with DNase. And then the structure of acellular valves was observed under light microscope, scanning and transmission electron microscope. Porcine endothelial cells, human endothelial cells, and canine myofibroblasts were reseeded onto the acellularized porcine heart valve scaffolds once a day for 3 days. The valves were analyzed by immunohistochemical staining and electron microscopy. Results show that all endothelial cells and the majority of interstitial cells were removed from the heart valves after digestion with trypsin for 104 h, and the collagen fiber structure remains intact, but the space between collagen fibers increased slightly. Incubation with trypsin for 80 h and then with DNase almost removed all cells, and the collagen fiber structure and the space between the fibers remain intact. After reseeding, human endothelial cells almost fully cover the valve scaffold surface as shown by H-E staining and platelet endothelial cell adhesion molecules (PECAM-1) staining. Xenogeneic porcine endothelial cells also adhered to and grew on the scaffolds. As shown by H-E staining and actin staining, canine myofibroblasts not only adhered to the surface of valve scaffold but also migrated to the inner part of matrix after one week culture. These results suggest that the digestion of porcine heart valves with trypsin combining with DNase is a suitable method to remove cells. The acellular porcine heart valve scaffolds have a quite favorable biocompatibility with human and porcine endothelial cells as well as canine myofibroblasts.
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Animals , Humans , Bioprosthesis , Cells, Cultured , Endothelium, Vascular , Cell Biology , Transplantation , Fibroblasts , Cell Biology , Heart Valve Prosthesis , Heart Valves , Cell Biology , Muscle Fibers, Skeletal , Cell Biology , Swine , Tissue EngineeringABSTRACT
0.01). No serious complications occurred. Conclusion Both PLD+IDET and PLD are very effective in treating lumbar disc herniation. IDET is very helpful in relieving low back pain, although it can hardly improve patient's daily activities.
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Many interventional procedures have been practiced in the treatment of cervical spine diseases for recent years. There are percutaneous biopsy, periradicular therapy for cervical never pain, percutaneous vertebroplasty and many kinds of intervertebral disc decompression. However, because of the manipulation difficulties and high risks of these procedures the popularization of interventional techniques in treating cervical spine disorders has actually been beset with difficulties. The main risks caused by interventional operation are puncture injuries and side-effect of therapeutic design. Therefore, how to reduce the procedure’s risk is a great challenge to interventional radiologists as well as an urgent research task.
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Interventional diagnostic and therapeutic techniques have developed rapidly in recent years with more and more practically and widely utilization as time goes by. The diagnostic procedures consist of percutaneous biopsy, CT discography, pressure measurement of intervertebral disc; and the therapeutic measures include percutaneous periradicular and joint therapy, decompression of sacral cyst, vertebroplasty, kyphoplasty, decompression of intervertebral disc, transarterial chemotherapy and embolization in spinal tumor, and newly developed percutaneous posterior lumbar intervertebral fusion. All above mentioned interventional techniques for spinal column diseases are developing day by day with a promising future and will play an important role in the field of interventional radiologist research.
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Percutaneous sacroplasty is a technique, derived from percutaneous vertebroplasty, with minimal invasion and better safety for refractory sacroiliac pain. The procedure is involved with bone cement injected into the diseased sacral body under fluoroscopic or computed tomography guidance and in turn for stabilizing and strengthening the vertebral body with outcome of decrease or even complete relief of pain. The author introduces and comprehends the definition, preoperative imaging examinations, indications, contraindications, techniques and complications of the procedure.