Carotid plaque composition and volume evaluated by multi-detector computed tomography angiography / 北京大学学报(医学版)

OBJECTIVE@#To evaluate the differences of plaquecomposition and volume between symptomatic and asymptomatic patients with carotid artery stenosis by multi-detector computed tomography angiography (MDCTA).@*METHODS@#The consecutive patients with internal carotid artery stenosis≥70% diagnosed by digital subtraction angiography (DSA) were retrospectively analyzed from July 2011 to December 2015 in Peking University China-Japan Friendship School of Clinical Medicine. The symptomatic patients were defined as those who experienced nondisabling ischemic stroke or transient cerebralis chemic symptoms, including hemispheric events oramaurosis fugaxin the last 6 months. Otherwise, the patients were considered as a symptomatic. A total of 78 patients were enrolled in the study. Of these patients, there were 35 asymptomatic patients (44.9%) and 43 symptomatic patients (55.1%). All the patients received MDCTA before DSA. According to the plaque analysis of post processing work station, carotid plaques were divided into lipid-rich necrotic coreplaques (HU≤60), fibrous plaques (60 to 130 HU) and calcified plaques (HU≥130) through the different value sthreshold of HU. The plaque volume and proportion were all calculated. The differences between the two groups were compared by statistical methods.@*RESULTS@#The proportion of calcified plaques in asymptomatic patients was significantly higher than in symptomatic patients (t=2.760, P=0.007).And the proportion of LRNC plaqueswas lower than that in symptomatic patients (Z=2.009, P=0.044). There was statistical significance between the asymptomatic and symptomatic patients. Multivariate analysis showed that there was a positive correlation between the proportion of calcified plaques and asymptomatic carotid artery stenosis (OR=0.949; 95%CI: 0.915 to 0.985; P=0.005). The proportion of LRNC plaques showed a negative correlation with asymptomatic carotid artery stenosis (OR=1.068; 95%CI: 1.021 to 1.117; P=0.004). For the symptomatic patients, when the LRNC plaque proportion was greater than 30.3%, the specificity was 94.3%, and the sensitivity was 37.2%. There was no significant difference in plaque volume and fibrous plaque proportion in both groups.@*CONCLUSION@#Compared with symptomatic carotid plaques, the proportion of asymptomatic calcified plaques increased but the proportion of LRNC plaques decreased. Plaque LRNC 30.3% of the total volume may represent a clinically useful cutoff. For the patients with carotid artery stenosis, MDCTA may help noninvasively risk-stratify patients.

Effect of electrochemotherapy in treating patients with venous malformations / 中国结合医学杂志

<p><b>OBJECTIVE</b>To evaluate the efficacy and safety of electrochemotherapy in treating venous malformations.</p><p><b>METHODS</b>Electrochemotherapy was applied to 665 patients with venous malformations of limbs and trunk, and 505 cases were followed up for half to 6 years. In this study, 228 male and 277 female patients were involved. Diagnosis was made by clinical manifestations and magnetic resonance imaging. The platinum electrodes were inserted into tumor through a trocar with plastic insulating cannula percutaneously and connected with the electrochemical therapeutic apparatus in anodes and cathodes separately. Then electricity was given. The treating voltage is 6-12 V and volume 100-180 mA, the total electricity used is in general 80-100 coulombs per 1.0 square centimeter of tumors' area. The treating time was usually from several dozen minutes to over 2 h depending on the size of the tumor. The severe cases which needed to be treated once again usually were operated after 6 months.</p><p><b>RESULTS</b>The primary efficacy end point was defined as an improvement of patients' symptoms and a reduction in size of tumor 6 months after treatment. Effects were divided into 4 grades, and the efficacy rate decreased from grade 1 to grade 4. The efficacy turned out that 30.1% (152/505) of patients was classified as grade 1; 46.3% (234/505) as grade 2; 19.0% (96/505) as grade 3 and 4.6% (23/505) as grade 4.</p><p><b>CONCLUSIONS</b>Electrochemotherapy shows special superiorities in treating venous malformations. It might bring a confirmed clinical efficacy with the advantages of less injury, quick recovery, simple operation and less complications.</p>

Open surgery for femoro-popliteal arterial occlusive disease / 中华外科杂志

<p><b>OBJECTIVE</b>To explore the mid-term surgical results of arterial revascularization for femoro-popliteal arterial occlusive disease (lesion type C and D).</p><p><b>METHODS</b>From January 2005 to February 2009, 191 arterial bypass had been performed on 170 patients (21 cases bilateral). There were 108 male and 62 female, age ranged from 45 to 85 years old with an average of 67 years old. The operative indication was claudication in 78 cases, rest pain in 62 cases, ischemic ulcer in 19 cases, and distal tissue necrosis in 11 cases. Arterial angiography were performed on all cases. According to TASC II document, type C lesions were seen in 127 limbs, type D lesions were seen in 64 limbs. Autogenous greater saphenous vein bypass in situ were done on 15 limbs, autogenous greater saphenous vein bypass reversed in 20 limbs, revascularization with artificial prosthesis in 128 limbs, composite grafts consisting of a prosthetic conduit with a distal venous segment in 28 limbs.</p><p><b>RESULTS</b>There were no 30-day mortality. Follow-up periods ranged 6 to 36 months with an average of (24 + or - 6) months. Seventy-three cases were lost during follow-up periods, follow-up rate was 57% (109/191). Primary patency rate was 84.4% (92/109). The patency rate was 88.2% with artificial prosthesis, 70.8% with greater saphenous vein (in situ or reversed). Secondary patency rate was 89.9%.</p><p><b>CONCLUSIONS</b>Arterial revascularization with artificial prosthesis is main treatment for diffused superficial femoral artery occlusive disease (TASC II type C and D lesion) with satisfied surgical results.</p>