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Objective To evaluate the efficacy of excimer laser atherectomy (ELA) combined with drug-coated balloon (DCB) in the treatment of lower limb arteriosclerosis obliterans.Methods From Sep 2016 to Dec 2018 42 patients (42 limbs) underwent ELA combined with DCB therapy.Results There were 27 males and 15 females.The mean age was (65.7 ±9.7) years.The average lesion length was (14.3 ±7.5) cm.The technical success rate was 100％ and the remission rate of clinical symptoms was 92.9％.Ankle-brachial index was significantly improved from (0.45 ± 0.15) pre-operation to (0.85 ± 0.13) postoperation (P =0.001).The mean follow-up was 10.9 months.At 3,6,and 12 months follow-up,the primary patency rate was 95.2％,92.8％ and 84.9％.The 1-year limb salvage rate was 95.2％.Conclusion ELA combined with DCB has a good 1-year results as our data reveal.
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Objective To investigate the clinical effects of percutaneous trasluminal angioplasty (PTA) for ischemic lesions of below-the-knee(BTK) arteries in elderly patients.Methods Clinical data of 56 elderly patients(the PTA group) with ischemic lesions of BTK arteries who had received PTA treatment were retrospectively analyzed.The ankle brachial index (ABI) and the skin temperature of the affected foot were recorded and analyzed before and after treatment.The clinical effects were compared with those of conservative treatment 31 patients(the control group) had received during the same period.Results PTA was successfully performed in all of the 56 cases.The skin temperature rose,claudication disappeared or the claudication distance increased,rest pain disappeared or lessened,and no severe complications or death occurred in the PTA group.ABI increased from (0.41±0.12) before treatment to(0.63±0.21),(0.65±0.19),(0.67± 0.22),(0.61±0.20),and (0.58±0.18) at 24 hours,1,3,6 and 12 months after treatment,respectively.The skin temperature increased from(28.4±2.1)℃ before treatment to(35.4±2.4)℃,(35.6±2.1)℃,(35.8±2.4)℃,(34.6±2.1)℃ and(34.3±2)℃ at 24 hours,1,3,6 and 12 months after treatment,respectively.There were statistically significant differences in ABI and the skin temperature between before treatment and any time point after treatment(all P＜0.05) and between the PTA group and the control group at any time point after treatment(all P＜0.05).Conclusions PTA is a safe and effective treatment for ischemic lesions of BTK arteries in elderly patients.
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Objective To analyze the effect of polydatin on cardiac function and mitochondrion of platelet in peripheral blood of patients with severe hemorrhagic shockpolydatin.Methods 60 patients with severe hemorrhagic shock from January 2010 to May 2015 in the hospital were selected.The control group adopted the intravenous therapy of normal saline and transfusion therapy and observation group adopted polydatin (10mg/kg) and transfusion therapy.After treatment, the cardiac function index including heart ejection fraction and and cardiac output, protein kinase C (PKC), ATP levels in mitochondria of platelet, platelet mitochondrial membrane potential and lipid peroxide ( LPO ) in platelet were compared between two groups.Results After treatment, the ejection fraction and cardiac output of two groups increased compared with pre-treatment ( P <0.05 ) , and the above indicators in observation group increased compared with control group (P<0.05).After treatment, PKC content in cell membrane and cytoplasm increased compared with pre-treatment (P<0.05), and the above indicators in observation group increased compared with control group (P<0.05). After treatment, the ATP level in two groups increased compared with pre-treatment (P<0.05), and the above indicator in observation group increased compared with control group ( P <0.05 ).After treatment, platelet cell rate of low mitochondrial membrane potential in observation group decreased compared with pre-treatment (P<0.05), but there was no significant difference in control group, the above indicator in observation group was lower than that in control group (P<0.05).After treatment, LPO content in observation group decreased compared with pre-treatment (P<0.05), but there was no significant difference in control group, the above indicator in observation group was lower than that in control group (P<0.05).Conclusion The injury of mitochondrion plays an important role in occurrence and development of severe hemorrhagic shockpolydatin.The function of peripheral blood platelet mitochondrion could be seen as a simple index of judging the state of shock.After the application of protective agent of mitochondrion, the function of mitochondrion is protected.The cardiac function is also improved.It has an important significance for the diagnosis of severe shock.
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Objective To discuss the clinical value of subintimal angioplasty (SIA) in treating long segment occlusion of superficial femoral artery (SFA) in the elderly,and to observe the follow-up results.Methods Subintimal angioplasty was performed in 66 elderly patients with stage Ⅱ-Ⅳ long segment occlusion of SFA.The improvement of ankle-brachial index (ABI) and the long-term patency rates were observed and analyzed before and after treatment.Results Of 66 elderly patients,the surgery was successfully performed in 64 cases (97 ％).Skin temperature was improved,the claudication disappeared or a claudication distance was prolonged,the rest pain disappeared or relieved,foot infection was under control and turned into the dry gangrene in these patients.SIA was given up in 1 case because the wire failed to return to the true lumen and the distal outflow segment was occluded.One patient underwent bypass grafting instead of SIA because the wire failed to get into the subintimal.The ABI got obvious improvement before and after treatment (0.59±0.16 vs.0.84± 0.21,P＜0.01).The patency rates in 62 patients undergoing SIA at 6,12,24,36 months were 85.5％ (53/62),69.4％ (43/62),54.8％ (34/62) and 48.4％ (30/62) after surgery,and the 3-years limb salvage rate in 62 cases was 96.6％ (60/62).Conclusions Subintimal angioplasty is an effective method for treating long segment occlusion of superficial femoral in elderly patients,and it has the satisfactory long-term follow-up results.
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Objective To evaluate the muscle mass in elderly patients with inguinal hernia using CT scan.Methods 30 male (age 70-90 years) hospitalized patients scheduled to receive surgery for inguinal hernia were selected into study group, 10 male health volunteers (40-50 years) were involved in adult control group, and 10 men of the same age as the study receiving annual physical examination were enrolled as elderly control group.General information were recorded;CT scanning of the stomach muscles and thigh muscles were conducted, and the muscle area was calculated using a special software.Results The index of grip strength in the study group was significantly lower than the adult control group [(36.44 ± 14.15) kg vs.(77.30 ± 22.69) kg, P =0.001], the calf circumference in the study group was significantly less than the adult control group [(25.18 ±2.31) cm vs.(27.62 ±2.33) cm, P =0.006].There was no significant difference in L3 abdominal area, subcutaneous fat area, abdominal fat area, and vertical spinal muscular volume between the study group and the adult control group;while the L3 abdominal muscle area and vertical spinal muscular mass was significantly less in the study group than in the adult control group [(12 094.23 ± 1 970.30) mm2 vs.(17462.00±1 600.58) mm2, P=0.001;(1 642.60±266.90) mm2 vs.(2 003.50±350.91) mm2,P =0.007].L3 skeletal muscle index of the study group was 50.64 ±7.52 and 66.7％ (20/30) of the study group had sarcopenia (≤52.4％).The CT findings of abdominal muscle of the study group were not significantly different from those of the elderly control group.The thigh muscle mass in the study group was significantly less than that in the control group (P =0.001), but there was no significant inter-group difference in thigh fat and femur areas (P ＞ 0.05).Conclusion The muscle mass and strength in elderly patients with inguinal hernia are significantly lower than those of adult controls, for which CT scan can be applied for assessment.
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Objective To evaluate the feasibility of precise hepatic segmentectomy or subsegmentectomy using intraoperative image-guided interventional intravascular segmental vessel balloon catheter occlusion of the segmental hepatic artery and portal vein.Methods 6 patients with liver resection carried out from 2011.3-2011.8 were retrospectively analyzed.Results The mean operating time was (270.83±21.31) min,the median of blood loss was 800 ml,the median of intraoperative transfusion volume was 450 ml.The tumors were mainly located in segments Ⅴ,Ⅵ,Ⅶ,Ⅷ.The mean diameter of tumor was (5.67±1.03) cm.Postoperative liver function in the first postoperative day showed the mean alanine aminotranferase (ALT) was (570.00±157.76) U/L,the mean aspirate aminotrarsferase (AST) was (410.00 ±189.94) U/L,and the mean total bilirubin (TBIL) was (10.83± 1.60) mmol/L.Liver function recovered to normal within 7 days.There was intestinal leakage and wound dehiscence in one patient,pleural and effusion in two patients.Conclusion Imageguided interventional intravascular segmental vessel balloon catheter occlusion was a safe and efficacious maneuver.This technique allowed hepatic segmentectomy or subsegmentectomy to be carried out,decreased intraoperative bleeding,and protected the function of the liver remnant.
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Objective To evaluate the effects of a carbohydrate-electrolyte solution on serum glucose, pancreas islet function and inflammatory response in elderly patients after abdominal operation.Methods It was a prospective, randomized, double-blinded and controlled trial. Totally 40 elderly patients after abdominal operation who met the defined criteria were enrolled. The subjects in study group were administered with 1000 ml carbohydrate-electrolyte solution intravenously in consecutive three days since 1st or 2nd postoperative day. Control group was administered with 1000 ml of 10% glucose on the same method. The changes of serum glucose, insulin, C-peptide and inflammatory response cytokine (IL-6, TNF-α, CRP) were detected before and after injection.Systemic inflammatory response syndrome (SIRS) was observed.Results All the 40 patients completed the study according to the study protocol. The incremental rate of serum glucose was significantly lower in study group than in control group on the 2nd and 3rd day after administration [(4.40±2.58) mmol/L vs. (14.97±3.44) mmol/L, t=2.984, P=0.008; (2.70± 1.55) mmol/L vs. (8.11± 2.60) mmol/L, t= 5.659, P= 0.000]. The changes of insulin and C-peptide of two group were similar before and after operation. The levels of IL-6 and TNF-α were significantly lower in study group than in control group on the 3rd day after administration[IL-6: (21.76±10.40) ng/Lvs. (50.17±35.24) ng/L, t=-2.447, P=0.034; TNF-α:(23.92±14.89) ng/L vs. (51.48±42.81) ng/L, t=-2.268, P=0.043]. In study group, 6 cases experienced SIRS and 4 cases had infective complications, but in control group the numbers were 8 and 6 respectively.Conclusions Appropriate application of carbohydrate-electrolyte solution intravenously has relatively mild effects on serum glucose and inflammatory response cytokine in elderly patients after abdominal operation, it decreases incidence of SIRS and maybe decrease infective complications.
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ObjectiveTo investigate the prevalence of nutritional risk and malnutrition among hospitalized elderly abdominal surgical patients with malignant tumors.MethodsTotally 269 elderly patents ( ≥ 65 years) with malignant tumor who were hospitalized in our department of abdominal surgery from December 2009 to November 2010 were consecutively enrolled.Nutritional Risk Screening 2002 ( NRS 2002 ) was performed on the next morning after admission.Body mass index (BMI) lower than 18.5 kg/m2 was considered as malnutrition.Results The NRS 2002 was completed in all the 269 enrolled patients.The overall prevalence of malnutrition was 30.1％ (81/269) ; more specifically,37.5％ (21/56) among geriatric patients ( ≥80 years) and 17.6％ (43/245) among the other age groups (P =0.001 ).The overall rate of nutrition risk was 38.3％ (103/269) ; more specifically,57.1％ (32/56) among the geriatric patients and 29.3％ (72/245) among the other age groups (P ＜0.001 ).The rate of nutrition risk in patients with pancreas cancer was 58.3％,which was higher than other elderly patients; on the contrary,and the rate of nutrition risk in the patients with colorectal cancer was relatively lower.ConclusionThe rates of nutrition risk and malnutrition in hospitalized elderly abdominal surgical patients ( ≥ 65years) with malignant tumor are relatively higher than other age groups,especially among the geriatric patients.
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Objective To explore the effects of L-carnitine on the plasma lipid profile and liver function in elderly patients receiving total parenteral nutrition after abdominal operations.Methods In this prospective blinded randomized controlled trial,24 eligible elderly patients were given 6-day total parenteral nutrition.They were further equally divided into L-carnitine group(administered with L-carnitine 50 mg/kg)and control group(without L-carnitine).The changes of lipid profile and liver function and the clinical outcomes were recorded and compared.Results The plasma triglyeride levels were lower in L-carnitine group than in control group on the 4th and 7th post-operative day,but there were not significant difference(P>0.05);There was a significant difference between the two groups in the change of the 4th post-operative day and pre-operative day(P<0.05).However,the liver function indicators were not significantly different between these two groups.Conclusion Administration of L-carnitine during total parenteral nutrition can improve the triglyeride metabolism in elderly patients after abdominal operations and may benefit the recovery of liver function.
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Objective To evaluate the clinical significance of implanting an inferior vena cava filter to prevent pulmonary embolism.Methods Reviewed the causality of 180 cases,which was undertaken the ultrasound examination,patients were diagnosed as the deep vein thrombosis,male patients were 128 cases, female patients were 52 cases,median age was 65 years old,all received the transfemora] implantation of inferior vena cava filter implantation.Results All the operations were successfully conducted,filters were placed into inferior vena cava at 1-3 cm inferior of renal vein,without hematoma in the puncture position and thrombosis.One hundred and forty-nine cases (82.8%) were followed up at 1,6,12 months respectively, 55 cases(30.6%)were followed up more than 36 months, no filter drift,deformation and inferior vena perforation complications was observed.There was no fatal pulmonary embolism occurred for all the cases,the inferior vena unobstructed rate was 95.6%.Conclusion Vena cava filter is an effective and safe method which can prevent and cure pulmonary embolism.
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ObjectiveTo evaluate the hemostatic effect of human thrombin in surgery.Methods A prospective, randomized, controlled and multicenter study was designed to evaluate the hemostatic effect of human thrombin on abdominal operation incision (96 cases) and liver wound (40 cases). Human thrombin was insufflated topically in study group, with 0 9% NS as control. Results The average hemostatic time of abdominal incision in study group was (104?70) s, hemorrhagic volume per square unit was (0 4?0 3)g/cm 2, in liver wound the average hemostatic time was (106?78) s, the hemorrhagic volume per square unit was (1 0?0 7) g/cm 2, the difference was all statistically significant ( P