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Objective:To investigate the clinical efficacy and safety of balloon compression-assisted endoscopic injection sclerotherapy (bc-EIS) for esophageal varices in patients with cirrhosis.Methods:From December 2020 to April 2021, cirrhotic patients with esophageal varices who planned to receive endoscopic treatment in the Department of Gastroenterology of the First Affiliated Hospital of Anhui Medical University were selected and randomly divided into the trial group (treated with bc-EIS) and the control group [treated with endoscopic variceal ligation (EVL)] through computer randomization. The varices eradication rate, rebleeding rate and postoperative adverse reactions in the two groups were studied.Results:During the study, 93 cases were initially included according to inclusion criteria, among which 9 cases were excluded by exclusion criteria. Finally, 84 cases were included for data analysis, with 42 cases in each group. The esophageal varices eradication rate after the first treatment in the trial group was 88.10% (37/42), which was significantly higher than that in the control group [33.33% (14/42)] ( χ2=26.40, P<0.001). The esophageal varices eradication rate after 1 to 2 times and 1 to 3 times of treatment in the trial group were both significantly higher than those in the control group [97.62% (41/42) VS 40.48% (17/42), χ2=29.47, P<0.001; 100.00% (42/42) VS 45.24% (19/42), P<0.001]. The maximum follow-up period was 6 months, and none of the patients had rebleeding in the trial group, and the rebleeding rate in the control group was 4.76% (2/42) ( P=0.494). The incidence of thoracic and abdominal discomfort, nausea and vomiting, and abdominal distension in the trial group and control group were 26.19% (11/42) and 35.71% (15/42) ( χ2=0.51, P=0.474), 2.38% (1/42) and 7.14% (3/42) ( χ2=0.26, P=0.608), and 4.76% (2/42) and 11.90% (5/42) ( χ2=0.62, P=0.430), respectively. No other adverse events such as infection, dysphagia, perforation, esophageal tracheal fistula, esophageal stenosis, or ectopic embolism occurred in any group. Conclusion:Bc-EIS is effective and safe for the treatment of esophageal varices in patients with cirrhosis, with a one-time varices eradication rate of more than 85%, and can be completely eradicated after 1 to 3 times of treatment.
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Objective:To evaluate the risks and benefits of endoscopic ligation and tissue adhesive injection for tortuous gastric varices.Methods:A total of 193 patients with esophagogastric varices, who underwent endoscopic variceal ligation or endoscopic tissue adhesive injection in Department of Gastroenterology of the First Affiliated Hospital of Anhui Medical University from June 2015 to June 2020, were included in the retrospective analysis. These cases were connected vessels (type Le and gf based on LDRf standard) of tortuous gastric varices (F1 in Hashizume standard). According to the treatment, the patients were divided into three groups: gastric fundus and esophageal ligation group (endoscopic ligation of gastric fundus and esophageal varices, 32 cases), tissue adhesive group (endoscopic tissue adhesive injection of gastric varices, endoscopic ligation of esophageal varices, 71 cases) and esophageal ligation group (endoscopic ligation of esophageal varices, 90 cases). The re-bleeding rate, the effectiveness rate, the significant effectiveness rate and complications of the three groups were compared.Results:The rates of re-bleeding in gastric fundus and esophageal ligation group, tissue adhesive group and esophageal ligation group were 18.75% (6/32), 12.68% (9/71) and 3.33% (3/90), respectively.There was significant difference only between gastric fundus and esophageal ligation group and esophageal ligation group ( χ2=6.110, P<0.016). The effectiveness rates of the three groups were all 100.00%. The significant effectiveness rates in gastric fundus and esophageal ligation group, tissue adhesive group and esophageal ligation group were 37.50% (12/32), 25.35% (18/71) and 14.44% (13/90), respectively. There was significant difference only between gastric fundus and esophageal ligation group and esophageal ligation group ( χ2=7.702, P<0.016). No pulmonary infection, hepatic encephalopathy, spontaneous bacterial peritonitis or perforation occurred in the three groups.The incidences of chest pain or abdominal pain in gastric fundus and esophageal ligation group, tissue adhesive group and esophageal ligation group were 18.75% (6/32), 11.27% (8/71) and 2.22% (2/90), respectively.There was significant difference only between gastric fundus and esophageal ligation group and esophageal ligation group ( χ2=10.524, P<0.016). There was no significant difference in the incidence of fever, nausea or vomiting among the three groups ( P>0.05). Conclusion:Simultaneous endoscopic ligation of gastric fundus and esophageal varices, and endoscopic tissue adhesive injection of gastric varices combined with endoscopic ligation of esophageal varices is of no benefit for patients with tortuous gastric varices, but endoscopic ligation of esophageal varices alone may yield more benefit.
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Objective:To explore the efficacy and safety of inflatable balloon compression-assisted endoscopic injection sclerotherapy (bc-EIS) in the treatment of esophago-gastric fundal varices (EGV).Methods:From June 12 to September 12, 2020, at the First Affiliated Hospital of Anhui Medical University, 38 patients with EGV who underwent bc-EIS were prospectively selected, the amount and the injection points of sclerosing medication were calculated, whether the injection point was bleeding during operation (no bleeding, oozing, spurting), whether compression was needed to stop bleeding (no need, needle sheath compression to stop bleeding, transparent cap compression to stop bleeding), early rebleeding after operation (72 h to 6 weeks after operation), delayed bleeding (six weeks after operation) were observed, and the number of treatments to achieve the complete elimination of varices were recorded. The postoperative follow-up period was one, three and six months to evaluate the efficacy and complications of bc-EIS. Descriptive methods were used for statistical analysis.Results:Among the 38 patients with EGV, there were 24 males and 14 females, aged (53.2±11.3) years old (ranged from 30 to 79 years old). During bc-EIS operation, the dosage of sclerosing medication of each patient was (20.03 ±7.49) mL (ranged from 6 to 40 mL), and the injection points of sclerosing medication were 4.97±1.83 (ranged from 2 to 10). The rates of complete disappearance of varices after the first, second and third time of bc-EIS were 71.1% (27/38), 89.5% (34/38) and 100.0% (38/38), respectively. Among the 38 patients with EGV, no postoperation varices related rebleeding occurred. During the follow-up two patients had hematemesis and melena within one month after operation. The endoscopic diagnosis was gastric varices bleeding below the cardia, which was improved after tissue glue injection under endoscopy. No severe adverse reactions such as fever, spontaneous bacterial peritonitis, hepatic encephalopathy, ectopic embolism, or death occurred in all patients after bc-EIS treatment.Conclusions:The dosage of sclerosing medication in bc-EIS is reduced by half compared with the recommended amount in the guidelines, and the injection point bleeding is less, moreover, the rate of complete disappearance rate of esophageal varices is more than 70% after the first treatment.
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Objective To evaluate the significance of selective salpingography(SSG)and fallopian tube recanalization(FTR)in diagnosis and treatment for obstructive infertility.Methods Totally, 268women with infertility caused by obstruction of the fallopian tube were divided randomly into two groups, one (Group A)with a non-operative hysterosalpingeal system by insertion of co-axial cannula and guiding filament made by COOK Corporation in the US and another(Group B)with a self-prepared hysterosalpingeal system modified based on the apparatus of COOK Corporation, for SSG and FTR.Then, efficacy of SSG and FTR for the infertile women was evaluated by one-year cumulative pregnancy rate and reeanalization rate of the fallopian tube.Resnits One hundred and seventy of 198 fallopian tubes were recanalized in Group A, with a recanalization rate of 85.8%, and 290 of 320 tubes in Group B were recanalized.with a recanalization rate of 90.6%.reaching statistically significant difference.Furthermore, recanalization rate varied with different sites of occlusion of the fallopian tube.Pregnancy rate was 35.3%(36/102)in Group A, significantly higher than that in Group B(47.6%, 79/166).As the same, pregnancy rate varied with different sites of occlusion of the fallopian tube.Conclusion Selective salpingography and fallopian tube recanalization with self-prepared hysterosalpingeal system have dual effects on diagnosis and treatment for tubal infertility of women, which are simpler, safer and more reliable, worth to be clinically applied.
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Objective: To discuss the possibility of using arc incision in the frontal neck for local-regional lymph excision in differentiated thyroid carcinoma of stage Ⅰand Ⅱ.Methods: A retrospective study was conducted on the results of the treatment of 56 cases of differentiated thyroid cancer in stage Ⅰand Ⅱ treated by thyroid lobectomy+isthmectomy+local-regional lymph nodes dissection.Results:Of all the 56 patients,only 2 developed postoperative complications,2 had cervical lymph nodes metastases after the operation,and none died.Conclusion: Arc incision in the frontal neck for lymphadenectomy of the central compartment could be applied as a routine treatment of differentiated thyroid carcinoma in stage Ⅰand Ⅱ.
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Objective To evaluate the efficacy and safety of transplantation of autologous bone marrow mesenchymal stem cells (BMSCs) and mononucleus cells (BMMNCs) for treating coronary heart disease. Methods Ten patients who had suffered from coronary heart disease with myocardial infarction, were selected. In 7 patients BMSCs+BMMNCs were transplanted immediately following PCI and 3 patients only accepted transplantation of BMSCs+BMMNCs without PCI. Autologous BMSCs+BMMNCs were isolated and cultured for 2-3 weeks. And (0.9～3.5)?106 BMSCs+1.6～6.1?106 BMMNCs were transplantated through intracoroary way. Cardiac functions were determined by 2-D echocardiography、 technetium- 99m methoxyisobutylisonitrile ( 99m Tc-MIBI) and ECG Holter monitor before and 6 months after the procedure. Results Left ventricular ejection fraction (LVEF) was significantly increased by 10.5% (4.0%-18.0%) and left ventricular diastolic diameter(LVDd) reduced by 2.2 mm (-4 mm-8 mm) and neither obvious arrhythmia nor complication was observed during the 6-12 months′ follow up in all the 10 patients. Conclusion The preliminary study showed that in the patients who suffered from coronary heart disease complicated with myocardiac infarction, transplantation of BMSCs+BMMNCs could improve cardiac function and cardiac perfusion without significant complication and arrhythmia during the 6-12 months′ follow-up.
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Objective To evaluate protective function of ischemia preconditioning for myocardium during percutaneous transluminal coronary angioplasty (PTCA), using cardiac troponin I (cTnI) as myocardial injury marker. Methods One hundred and fifty patients with coronary artery disease (CAD) undergoing PTCA were divided into two groups: Group Usual Cure (G-UC), including 120 cases, and Group Ischemia Precondition (G-IP), including 30 cases. Serum cTnI were measured before and 6, 12, 24, 48 and 72 hours after the procedure respectively. The relative factors were analyzed. The cardiac events were followed-up.Results The serum cTnI levels of 29 cases elevated in G-UC, while those of 2 cases elevated in G-IP. There was statistical difference on elevated cTnI levels between the two groups (P
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Objective To study the angiogenic effects of adenovirus mediated human vascular endothelial growth factor 165 and human angiopoietin-1 (Ad 5-VEGF 165 , Ad 5-Ang-1) in rat models of hindlimb ischemia. Methods Rat models of hindlimb ischemia were established by ligation and peeling off rat′s femoral arteries. Ad-VEGF 165 and Ad-Ang-1 were intramuscularly transferred into the rat ischemic hindlimbs. The expression of VEGF 165 and Ang-1 were examined by Western blotting. Immunohistochemistry was performed to illustrate the effects on rat ischemic muscles after gene transferring. Results (1) Western blotting showed a high expression of VEGF 165 and Ang-1 in the ischemic hindlimb muscle transferred with Ad 5-VEGF 165 and Ad 5-Ang-1 VEGF 165 respectively. (2) There was no significant difference between groups on 7 days after the transfer. The capillary to muscle fiber ratio was significantly higher in the treating groups than that in control groups and were significantly higher in VEGF 165 +Ang-1 group than in VEGF 165 or in Ang-1 groups on day 14th and day 21th. (3) Many structured vessels surrounded by a layer of smooth muscle cells were found in Ad-VEGF 165 and Ad-VEGF 165 +Ad-Ang-1 groups, the number of SMA + vessel per muscle fiber was obviously higher than those in control groups. (4) Enormous cells positive for BrdU appeared in treated muscles in Ang-1, VEGF 165 , VEGF 165 +Ang-1 groups and many of them were positive for C-Kit, an antigen expressed by pluripotent marrow stem cells. Some C-Kit+ cells were incorporated in sites of neovascularization. Conclusion (1) Vascular endothelial growth factor 165 and angiopoietin-1 can promote neovascularization in rat models of hindlimb ischemia and the angiogenic effect is much more significant in Ad-VEGF+Ad-Ang-1 group. (2) VEGF 165 can increase the number of vessles that are coated with smooth muscle cells which shapes are similar to arterioles. (3) Not only angiogenic effect but perhaps vasculogenic effct also contribute to the neovascularization.