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<p><b>OBJECTIVE</b>To determine and analyze plasma ammonia concentration difference of the portal vein system and ramifications of rabbits and consequently guide selection of the portal vein in transjugular intrahepatic portosystemic shunt (TIPS) so that reduce shunt-induced hepatic encephalopathic incidence. To evaluate clinical significance of transjugular intrahepatic left branch of portal vein portosystemic shunt (TILPS) and to analyse hemodynamics of both branches of the portal vein and to observe long-term results in the prevention of encephalopathy.</p><p><b>METHODS</b>Blood samples in different portal vein branches of rabbits were collected and the plasma ammonia concentration was assayed and compared. The left branch of portal vein was used as the puncture site to perform TILPS and to keep away from the right branch of portal vein blood that contains nutrition and toxin.</p><p><b>RESULTS</b>Plasma ammonia content was superior in the mesenteric vein and higher than the portal vein branch, the splenic vein, and the vena cava. The right portal vein was above the left. Encephalopathy did not occur in all patients within 3 months. Of the 341 patients undergoing TILPS, encephalopathy occurred in only 5 patients (1.47%) and shunt abnormalities in 19 patients (5.57%) verified by venography during overall follow-up period.</p><p><b>CONCLUSIONS</b>Selective left branch of the portal vein portosystemic shunt can decrease encephalopathy obviously and protect liver function.</p>
Subject(s)
Adult , Aged , Animals , Female , Humans , Male , Middle Aged , Rabbits , Ammonia , Blood , Follow-Up Studies , Hepatic Encephalopathy , Blood , Portal Vein , General Surgery , Portasystemic Shunt, Transjugular Intrahepatic , Treatment OutcomeABSTRACT
Objective To evaluate the clinical applications and limitations of helical CT virtual cystoscopy (CTVC).Methods CTVC was performed in 36 patients suspected bladder diseases, all cases were confirmed by conventional cystoscopy and pathology. CTVC images were generated from the volumetric data of the excretory phase using helical CT. The results were then compared with the findings of axial images and conventional cystoscopy in a double-blinded manner. Results CTVC could clearly display the normal anatomic structures of bladder, 11 ureteric orifices were visualized at CTVC in 7 of 8 normal bladders. The location, size, numbers, configuration and extension of lesions showed on CTVC were corresponded well with that of conventional cystoscopy. The sensitivity to vesical carcinoma was 94.7%,2 tumors smaller than 5 mm depicted on CTVC images were not seen on the axial images, whereas areas of wall thickening and extravesical invasions were more readily appreciated on axial and MPR images. There was 1 false lesions detected on CTVC images. Conclusion CTVC has proved to be a noninvasive and reliable technique in the detection and diagnosis of bladder lesions, but the optimal evaluation requires adequate bladder filling with contrast medium, and should combine with the interpretation of axial and MPR images.
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Objective To evaluate the clinical applications of helical CT scans in the ureteral diseases.Methods The precontrast and four-phase postcontrast helical CT scans were performed in 110 patients with ureteral diseases confirmed by clinic and pathology, and the multiplanar reformation (MPR) and three-dimensional reconstruction (3D) images were generated from the volumetric data.The ability of helical CT in detecting and diagnosing the ureteral diseases was investigated.The results were then compared with the findings of the other imaging techniques and surgery.Results Combined with axial and MPR images, the location, size, morphology, extension, and the urinary obstruction of the ureteral diseases could be clearly demonstrated in 97.3% cases, and the curved MPR was useful in directly detecting the lesions.The findings of ureteral lesion on helical CT images corresponded well with that of surgery in 81 cases. 3D reconstruction could produce a three-dimensional image that mimics conventional urography, and was useful in displaying the ureteral lesions from multiple views.Helical CT could compensate for some disadvantages of the other imaging techniques.Conclusion Helical CT, with large scanning area and high resolution, can provide comprehensive information about the ureteral diseases, and the curve MPR has the highest value.
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Objective To estimate the accuracy of MR angiography(MRA) and CT angiography(CTA) in the evaluation of the carotid artery stenosis. Methods Eleven patients were studied with MRA and CTA. The results were compared with DSA, CT virtual endoscopy (CTVE), and Doppler ultrasound (DUS). MRA was performed with 2D and 3D TOF sequences. CTA was postprocessed using MIP and SSD. CTVE was performed using navigator function . Three patients with severe stenosis received carotid endarterectomy. Results There was a total of 22 carotid arteries studied, with 8 mild, 3 moderate, 5 severe stenosis, 1 occlusion, and 5 normal. Agreement on stenosis between CTA and DSA was found in 11 of 12 carotid arteries. Agreement on stenosis between MRA and DSA was found in 9. Plaques were delineated in CTA, CTVE, and confirmed by pathology in 3 cases. Postoperative MRA and CTA proved the release of stenosis. Conclusion MRA and DUS can be used as a screening technique to evaluate carotid artery stenosis and as a convenient follow up modality for post endarterectomy. CTA has a high degree of accuracy for the assessment of carotid artery stenosis compared with DSA, and it could provide information on calcified plaque.