ABSTRACT
Objective To preliminary evaluate the mid-term clinical effect of endovascular repair in treating spontaneous extracranial internal carotid artery (ICA) dissection,and to observe the patency of stent.Methods The clinical data and imaging materials of 6 patients with spontaneous extracranial ICA dissection,who were treated with endovascular repair during the period from March 2012 to December 2012,were retrospectively analyzed.The U.S.National Institute of Heahh Stroke Scale (NIHSS) scores were determined before and after endovascular repair,and the postoperative stent patency condition was assessed,the results were analyzed.Results A total of 6 patients,including 4 males and 2 females with a median age of 50 years old (40.75-54.75 years old),received endovascular repair therapy.The median interval from the onset of disease to accept endovascular treatment was 10 days (one week-3 months).After the implantation of stent,the blood flow in the true lumen returned to normal immediately,although part of the false lumen was still filled with contrast agent.Embolism of retinal artery occurred in one patient during the operation,no death occurred.The median follow-up time was 54.4 months (49.7-57.9 months).The NIHSS score determined at the last follow-up visit was not significantly different from the preoperative one (P=0.102).Imaging reexamination revealed that the false lumen at the ICA stent segment disappeared in all 6 patients,and no obvious in-stent stenotic changes were observed.Conclusion Endovascular therapy of selected symptomatic extracranial carotid artery dissection with bare stents can effectively prevent the recurrence of clinical symptoms and promote ICA remodeling with excellent mid-term patency.
ABSTRACT
Objective To investigate the killing effect of polymethylmethacrylate (PMMA) on spinal metastasis of transplanted VX2 carcinoma in experimental rabbit models. Methods Spinal metastasis of transplanted VX2 carcinoma model was successfully established in 18 rabbits. The experimental rabbits were randomly and equally divided into three groups with 6 rabbits in each group. Under CT guidance , PMMA or saline was injected into the center of VX2 tumor; in group A 0.3 ml of PMMA was used, in group B 0.1 ml of PMMA was used and in group C (control group) 0.3 ml saline was used. Twenty-four hours after the injection, the animals were sacrificed. Four tissue samples were obtained from the sites at 1 mm , 5 mm, 10 mm and 15 mm away from the PMMA mass in each rabbit of group A and group B , while four tissue samples were collected from different four sites from the tumor ’s center to border in each rabbit of group C. TdT-mediated dUTP nick-end labeling (TUNEL) method was used to determine the tumor cell apoptosis rate. Results After successful establishment of rabbit model, injection of PMMA was performed in sixteen among the eighteen rabbits. Technical success rates were 83.3% in both group A and B, and the success rate was 100% in group C. The difference in technical success rate was not significant. The mean tumor cell apoptosis rates of spinal VX2 carcinoma at 1 mm, 5 mm and 10 mm away from the PMMA mass in group A were (65.75±18.81)%, (50.00±14.24)% and(14.95±8.98)% respectively. The mean apoptosis rate in the control group was (9.79 ±5.24)%; the differences between the group A and the control group were statistically significant (P<0.05). The mean tumor cell apoptosis rate of spinal VX2 carcinoma at 15 mm away from the PMMA mass in group A was (10.30 ±8.13)%, which was not significantly different with that of the control group. The mean tumor cell apoptosis rates of spinal VX2 carcinoma at 1 mm and 5 mm away from the PMMA mass in group B were (49.20±15.57)% and(17.75±9.28)% respectively, which was significantly different with that of the control group(P<0.05); the mean tumor cell apoptosis rates at 10 mm and 15 mm away from the PMMA mass in group B were not significantly different with those of the control group. Statistically significant differences in the mean tumor cell apoptosis rates determined at 1 mm, 5 mm and 10 mm away from the PMMA mass existed between group A and group B(P<0.001). Conclusion PMMA can promote the apoptosis of tumor cells, properly increasing the injected amount of PMMA can enlarge the extent of tumor cell apoptosis.
ABSTRACT
The distribution and prevalence of low pathogenic avian influenza virus in major live poultry wholesale markets around the Dongting Lake region ,China were investigated in our study to propose prevention and control measures on low pathogenic avian flu in the area of live poultry wholesale market .The samples were injected to SPF chicken embryos by allanto-ic cavity ,and then the allantoic fluid were harvested and used for hemagglutination (HA) .If it was positive by HA ,subtypes of the virus would be determined by hemagglutination inhibition (HI) and RT-PCT .We isolated 627 low pathogenic avian in-fluenza viruses in major live poultry wholesale market around Dongting Lake region systematically in winter and spring during 2009-2011 ,and the total separation rate was 22 .2% .The duck swab separation rate of low pathogenic avian influenza was the highest ,which was 24 .6% ,and the following was chicken swab that reached 21 .5% ,and the goose swab separation rate was 11% .We isolated 6 HA subtypes including H3 ,H4 ,H6 ,H9 ,H10 ,and H11 in every live poultry wholesale market ,and the separation rate of H9 ,H6 and H4 subtypes was relatively high ,which could reach 11% ,6 .3% and 3 .4% ,respectively . Those results indicated that recessive infection of low pathogenic avian influenza virus was serious in live poultry wholesale mar-ket around the Dongting Lake area ,and it was a great threat to the occurrence of avian flu .
ABSTRACT
Objective To evaluate the efficacy of medical therapy in the patients with osteoporotic vertebrae fracture. Methods The patients suffered from vertebrae fracture and had undergone percutaneous vertebroplasty operation were reviewed from May, 2006 to December, 2009. Informations were collected via case evaluation and telephone interview, regarding dual-energy X-ray absorptiometry(DXA), calcium and vitamin D supplementation,and anti-osteoporosis drugs treatment. Patients with fracture induced by trauma and tumor metastasis were excluded. Results Among 253 patients, DXA was performed only in 3.6% of patients. Calcium and vitamin D supplements were prescribed in 9.5% and 6.7% of patients, respectively. Anti-osteoporosis drugs were prescribed in 36% of patients, of them 27.5%, 29.7%, 2.2%, and 3.3% received bisphosphonate, calcitonin, ossotide, and traditional Chinese drugs respectively. 37. 4% of patients could not recall the name of the drug they had received. Conclusions Most patients with osteoporotic vertebrae fracture do not receive adequate anti-osteoporosis drugs or appropriate evaluation. More care should be given to the patients with vertebrae fracture, with regard to adequate drug treatment and appropriate evaluation in order to prevent future fractures.
ABSTRACT
Objective To investigate the value of positron emisson tomography-computed tomography ( PET-CT) in monitoring the residual lesions in lipiodol sedimentary region and extrahepatic metastastic lesions of hepatocellular carcinoma ( HCC) with alpha fetoproteins ( AFP) positive after interventional therapy. Methods The data of 20 cases with primary HCC confirmed by histopathology were retrospectively analyzed. Their AFP levels decreased to normal range after interventional treatments, but rose to abnormal high level during following-up. After the abdominal routine imaging examinations, the definite diagnosis of the residual lesions in lipiodol sedimentary region or extrahepatic lesions can't be made confidently. All cases were scanned by PET-CT, and according to their PET-CT results, the further treatments were given and the therapeutic results were monitored with radiology and AFP tests. Results In all 20 cases, 10 of them were detected to have the extrahepatic metastastic lesions by PET-CT, including 4 with abdominal wall metastasis upon the liver, 3 with solitary pulmonary metastasis with diameter less than 1 cm, 2 with mesenteric mestastasis, 1 with mestastasis of operative incisions, but these lesions were neglected by abdominal routine imaging examinations. Eight cases showed the uneven lipiodol sedimentary region in the primary lesion by CT or MRI examination, but can't be diagnosed whether it was residual lesion with other examinations including DSA. A definite diagnosis was obtained by PET-CT. In 2 cases, lymph nodes less than 1. 5 cm were found in the hepatic portal area(PHA) and retroperitoneum on CT images,which was determined to be metastatic by PET-CT. All the detected lesions were given further treatments of surgery or interventional therapy. Most patients showed decreased AFP levels except the 2 patients with lymph node metastasis. The imaging examinations also indicated that the treatments had a good effect on lesions. Conclusion In the patients with HCC and abnormal high levels of AFP, in addition to abdominal routine imaging examinations, PET-CT is beneficial for those who is suspected of residual lesions in lipiodol sedimentary region or extrahepatic metastasis.
ABSTRACT
Objective To investigate the changes in function of liver and kidney of the rabbits bearing VX2 liver tumor after transarterial embolization and hyperthermia with magnetic nanoparticles suspended in lipiodol(MN-L) and its therapeutic effect Methods Thirty-two rabbits bearing VX2 liver tumor were randomly divided into four groups and each group contained 8 rabbits The four groups were MN-L embolization hyperthermia group (Group A), MN-L embolization group(Group B),Lipiodol embolization group(Group C), and Control group (Group D), Each rabbit in Group A and B was embolized with 0.5-0.8 ml MN-L through hepatic artery, while each rabbit in Group C was embolized with 0.5-0.8 ml lipiodol.Hyperthermia in alternating magnetic field was performed in Group A after embolization.The remaining groups did not undergo hyperthermia.The rabbits in control group were not treated.The function of liver and kidney of all the animals was measured 1d before embolization,and 1,7,and 14 d after embolization/hyperthermia respectively.Alanine aminotransferase (ALT) and aspartate aminotransaminase (AST) were used to reflect the function of liver,and blood urea nitrogen(BUN) and creatinine (Cr) were used to reflect the function of kidney.CT was performed on all of subjects before and after embolization to determine the embolization effect and the tumor size, and follow-up CT was performed weekly.All of subjects were sacrificed 14 days after embolization/hyperthermia, and their livers, spleens, kidneys and lungs were removed for histopathology examination.The data from every group were analyzed using analysis of variance of repeated measure data.Results On 1 day before embolization and 1,7, and 14 d after embolization/hyperthermia, the function of liver of the rabbits was as follows:Group A:ALT was (43.9±19.0),(795.1±327.1),(67.0±9.3), and(41.9±10.8) U/L respectively,and AST was (50.2±13.6),(1011.2±655.9),(62.4±24.1),and(51.6±7.9) U/L respectively; Group B: ALT was(45.0±19.1),(580.8±160.4),(67.2±31.0),and(47.6±7.8) U/L respectively, and AST was (52.9±20.3),(735.2±186.1),(57.9±24.8),and (50.9±9.8) U/L respectively; Group C: ALT was (47.4±14.6),(558.5±167.8),(63.5±21.9),and (48.0±9.3) U/L respectively, and AST was (51.8±9.5),(752.5±112.0),(56.5±20.6),and(51.4±8.6) U/L respectively.Both ALT and AST mean values of the rabbits were significantly elevated 1 d after embolization/hyperthermia in Group A, B and C, and the data showed statistically significant difference comparing with that before therapy and that of Group D 1 d after therapy (P<0.01).The function of liver showed no statistically significant difference between 7 or 14 days after embolization and 1 day before embolization in Group A,B and C. BUN and Cr mean values in pre-embolization and post-embolization rabbits revealed no statistically significant difference in group A, B, C and D.The MN-L /lipiodol were deposited in the tumor when it was injected, which was validated by CT.To compare with immediate CT after embolization, the MN-L deposited in tumors was not significantly different on CT 7 d after embolization .On the 14 th day after treatment,the MN-L deposited in tumors became concentrative and compact in Group A, while the MN-L/lipiodol deposited at the rim of tumors disappeared on CT in five rabbits of Group B and C.And the tumor size decreased by 21.7% compared to that before treatment in Group A [from (7.8±1.4)cm~3 to(6.1±0.6) cm~3,F=17.56, P<0.01], but tumor size increased by 16.2% and 18.9% in Group B and C respectively [from (7.9±1.1)and (7.8±0.9)cm~3 to (9.1±0.8) and (9.3±1.0)cm~3, F =25.23,55.50, P<0.01].Histopathologically, the tumor of Group A was necrotic for at least 80% 14 day after embolization, while the tumor of Group B and C was necrotic for 30% to 50% .Conclusion Transarterial embolization and hyperthermia with MN-L is safe, effective and feasible on the rabbits bearing VX2 liver tumor.
ABSTRACT
Objective To assess the long-term outcomes as well as the living quality of the patients with lumbar disc herniation (LDH) after the treatment of percutaneous lumbar discectomy (PLD), and to discuss the influential factors related to the long-term effectiveness. Methods During the period of January 2000 to March 2002, PLD was performed in 129 patients with LDH. By using self-evaluation questionnaires of Oswestry disability index (ODI), Short Form-36 (SF-36) and Japanese Orthopaedic Association (JOA) through letter or telephone interviews as well as the patients' initial medical records, the related clinical data were collected. Statistical analysis was conducted by using Wilcoxon's rank sum test, Chi-square test. Results One hundred and eight patients (83.7%) were able to be followed up and 104 effective ques-tionnaires were collected. The mean follow-up time was (6.64 ± 0.67) years, the excellent rate (ODI score, 0 ～ 20%) was 71.15%. The average scores of the JOA and SF-36 was 23.66 ± 5.72 and 75.88 ± 25.57, respectively. The scores of quality of life were obviously improved in all follow-up subscales. Conventional operations were carried out subsequently in 9 patients as they failed to respond to PLD. No complications related to PLD occurred in this study. The age, course of the disease and the patient's condition at the time of discharge might bear a relationship to long-term effectiveness. Conclusion PLD is a safe and minimally-invasive technique for the treatment of LDH with quick and reliable effect, PLD can dramatically improve the quality of life. Many factors, such as the age, course of the disease and the patient's condition at the time of discharge, can affect the long-term outcomes.
ABSTRACT
Objective To investigate the trans-arterial delivery of p53 gene transfection efficiency and therapy effect on hepatic carcinoma in combination with transferrin mediated by liposome. Methods Twenty-five VX2 experimental rabbits were randomly divided into five groups, and the different doses of transferrin combined with p53-LipofectAMINE complex were delivered into the hepatic arteries of the VX2 hepatic carcinoma models. The tissue protein of the carcinoma was extracted after 48 h and the transfection efficiency and expression rate of p53 gene were analyzed by western blot and immune histochemical techniques, to inspect the expression proportion of p53 with different doses transferring. Another ten VX2 were divided into two groups, recombinant plasmid p53-LipofectAMINE complex and transferrin-p53-LipofectAMINE complex were delivered into the hepatic arteries in two groups respectively. The liver function, size of the tumor and survival time of the animals was compared between the two groups, and results were analyzed statistically. Results Semiquantitative analysis by Western Blot showed that the transfection and expression efficiency of p53 gene combined with transferrin were higher than those without it. By immune histochemieal techniques, the p53 gene's positive rate of highly expression with various doses of transferrin were found to be different, and there was remarkable difference between the groups with and without transferring. They were 58. 33%, 69. 44%, 80. 00%, 83.33%, 81.67% respectively, there was remarkable difference between the groups with and without transferring ( Totality: x2 = 42. 37, P < 0. 01 ). The p53 gene's positive rate of expression increased gradually as the doses of transferrin increasing from 0 up to 200 μg, but the differences of positive rate had no statistical significance as the doses of transferrin increasing from 200 up to 400 μg ( x2 section : 3 groups as former x2 = 4. 82, P < 0. 05,3 groups as latter x2 =0. 67 ,P <0. 05). There was no statistical difference in the liver function at points of time between VX2 rabbits with and without transferring. But the tumors' sizes had significant difference at various points of time. Conclusion Liposome-mediated p53 gene on treating hepatic carcinoma by trans-arterial gene delivery combined with transferrin is safe, and it can markedly enhance transfection efficiency and improve the therapy effect of p53 gene.
ABSTRACT
Objective To assess the long-term outcomes as well as the living quality of the patients with lumbar disc herniation(LDH) after the treatment of percutaneous lumbar discectomy(PLD),and to discuss the influential factors related to the long-term effectiveness.Methods During the period of January 2000 to March 2002,PLD was performed in 129 patients with LDH.By using self-evaluation questionnaires of Oswestry disability index(ODI),Short Form-36(SF-36) and Japanese Orthopaedic Association(JOA) through letter or telephone interviews as well as the patients’ initial medical records,the related clinical data were collected.Statistical analysis was conducted by using Wilcoxon’s rank sum test,Chi-square test.Results One hundred and eight patients(83.7%) were able to be followed up and 104 effective ques-tionnaires were collected.The mean follow-up time was(6.64 ? 0.67) years,the excellent rate(ODI score,0 ～ 20%) was 71.15%.The average scores of the JOA and SF-36 was 23.66 ? 5.72 and 75.88 ? 25.57,respectively.The scores of quality of life were obviously improved in all follow-up subscales.Conventional operations were carried out subsequently in 9 patients as they failed to respond to PLD.No complications related to PLD occurred in this study.The age,course of the disease and the patient’s condition at the time of discharge might bear a relationship to long-term effectiveness.Conclusion PLD is a safe and minimally-invasive technique for the treatment of LDH with quick and reliable effect.PLD can dramatically improve the quality of life.Many factors,such as the age,course of the disease and the patient’s condition at the time of discharge,can affect the long-term outcomes.
ABSTRACT
Objective To explore the feasibility and value of treating esophageal thoracic fistula with covered esophageal stent through nasal esophagus drainage tube. Methods Seven patients with esophageal thoracic cavity fistula were enrolled and treated by 5F pigtail side-holes catheter inserting into thoracic cavity for drainage and then again through nasal esophagus and fistula, placing a covered stent in the esophagus to occlude the orifice of the fistula. The abscess cavities were washed and radiographied periodically through drainage tubes. Results The insertion of the drainage tube and the placement of covered stent were all successful. The drainage tubes were placed in abscess cavities for 12-22 days, average 15 days. The radiography through drainage tubes showed that the abscess cavities disappeared or shrank obviously with control of hydropneumothorax before the drainage tubes being pulled out. The esophagogram after withdrawal of the drainage tubes notified that the fistulae were occluded satisfactorily with stents expanded fully without displacement and stenosis. Conclusions Treating esophageal thoracic cavity fistula with covered esophageal stent through nasal esophagus drainage tube is feasible and safe with clinical efficiency.
ABSTRACT
Percutaneous vertebroplasty (PVP) is a relative new interventional technique, which is widely used in treatment of vertebral collapse caused by vertebral neoplasms and osteoporotic compression fractures. The general technical considerations of PVP techniques are discussed based on authors' experience obtained over 400 patients in the past years in this article, including preparation of PMMA, instrument of PVP, guidance and puncture approaches, and technique of the procedure, etc. The conclusion is that PVP is a safe procedure if the physicians handle it properly.
ABSTRACT
A study of 10 cadavers and 100 CT scans of lumbar spine was performed to investigate the topographical anatomy of the posterolateral disc puncture in percutaneous lumbar discectomy.A way of the puncture at L_5-S_1 disc,with comparative plain films of lumbar spine in different positions were taken in 50 cases.The results showed that the pos- terolateral approach for percutaneous discectony was a safe way.However,it is important to have full knowledge of the regional topographical anatomy associated with the puncture tech- nique to avoid the potential neurovascular complications.The special position designed by authors for the puncture at L_5-S_1 disc is useful by lowering the position of iliac crest which hinders the entrance of needle,thus can raise the successful rate of the percutaneous discec- tomy 100% successful rate of the disc puncture at L_5-S_1 disc was obtained in 130 cases.The two puncture parameters of Chinese associated with percutaneous lumbar discectomy were first measured;and also the route including nearby structures,the complications were dis- cussed.
ABSTRACT
Objective To explore the feasibility of using rotating pliers system for treating lumbar disc herniation with concomitant prolapse.Methods Ex vivo incision experiment was performed on 8 lumbar discs of 2 pigs using rotating pliers. Clinical application included 12 patients of lumbar disc herniation shown by CT or MRI. 40% herniations excerted enough pressure on dural sac with concomitant prolapse of different degrees. The symptoms and image findings were concordant. The herniated nucleus pulposus were resected using rotaing pliers system, MacNab standard was applied for the clinical evaluation. Results The ex vivo experiments and clinical application were successful. Clinical application showed CR in 4 patients (33.3%), PR in 5 patients (41.7%) and NR in 3 patients (25.0%). CT demonstrated the herniated disk tissue retraction of different degrees in CR and PR patients, together with decrease in CT attenuation number, ranging from 8 30 HU, 18?5HU in average but no changes in NR patients.Conclusions Percutaneous lumbar diskectomy is safe and effective to treat lumbar disc herniation with concomitant prolapse by using rotating pliers systems and thus extending the PLD application.