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Objective:To analyze the safety and clinical efficacy of invasive treatment for portal vein thrombosis after splenectomy or devascularization.Methods:Invasive treatment was retrospectively analyzed from Jan 2016 to Jan 2020. In 319 cases who met the inclusion criteria.Result:There were complications in 41 cases and no death;The average portal vein pressure before and after thrombus clearance treatment was (25.6±4.9) mmHg and (14.7±4.1) mmHg respectively ( t=2.53, P<0.05); Thrombus decreased significantly in most patients. Conclusion:Invasive therapy is a safe and effective method for patients complicated with portal vein thrombosis after splenectomy or devascularization.
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Objective:By using balloon occlusive hepatic angiography in cirrhotic portal hypertension to evaluate contrast doses on the detection rate of intrahepatic venous-lateral branch shunt (HVVC), and the effect on hepatic venous pressure gradient (HVPG) and portal vein pressure gradient (PPG).Methods:From Jan 2018 to Jun 2021, 131 patients received transjugular intrahepatic portosystemic shunt (TIPS) at Beijing Shijitan Hospital.Results:A positive correlation between PVP and weged hepatic venous pressure (WHVP) ( r=0.241, P=0.001) was found when only by right hepatic vein approach. Ten ml of iodine contrast medium when compared to 5ml doses found more cases of intrahepatic venous-venous lateral branch shunt. The mean PPG of patients with HVVC was significantly higher than the mean of HVPG( P<0.05).The right hepatic vein was the only reliable vein by which WHVP was measured. Conclusions:Right hepatic vein manometry,adequate ballon occlusion and using 10ml of iodine contrast help get reliable WHVP and found HVVC; HVVC can affect the consistency of HVPG and PPG.
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Objective:To study the efficacy of direct intrahepatic portosystemic shunt (DIPS) in treatment of Budd-Chiari syndrome (BCS).Methods:From January 1, 2015 to June 31, 2017, consecutive patients with BCS who were treated with DIPS at the Department of Interventional Therapy of Beijing Shijitan Hospital, the Liver Disease Research Center of Beijing Friendship Hospital and the General Surgery Department of Beijing Ditan Hospital were retrospectively analyzed. The symptoms, physical signs (including abdominal distension, ascites, pleural effusion, splenomegaly, hepatic encephalopathy) and perioperative laboratory results of these patients were collected and analyzed. Biochemical indicators including alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin (TBil), direct bilirubin (DBil), and portal pressure gradient were compared before and 2 weeks after treatment. The patients were followed up for at least 3 years to assess their clinical symptoms, patency of shunt, oncological status and survival.Results:Of 67 patients with BCS who were included in the study, there were 45 males and 22 females, aged (38.12±23.22) years. The BCS classification of these patients were hepatic vein type ( n=65), including 62 patients with complete hepatic vein obstruction, 3 patients with hepatic vein occlusion due to thrombosis, and 2 patients with mixed hepatic vein and inferior vena cava occlusion. All 67 patients underwent DIPS with 93 stents being implanted. In addition, 43 patients underwent gastric coronary vein embolization, and 2 patients with mixed type of BCS underwent inferior vena cava stenting. The portal pressure gradient decreased from (22.17±9.16) mmHg (1 mmHg=0.133 kPa) to (9.87±4.75) mmHg, the difference was statistically significant ( P<0.05). Abdominal distension was relieved, at one month and ascites completely subsided in 3 months after operation. The liver congestion and swelling were obviously relieved. Comparison of patients 2 weeks after operation and before operation, ALT decreased from (65.28±27.75) U/L to (28.43±13.46)U/L, AST from (68.75±29.23) U/L to (26.92±13.33)U/L, TBil from (175.31±80.48)μmol/L to (45.08±26.54)μmol/L, DBil from (127.55±44.65)μmol/L to (35.12±10.77)μmol/L, and albumin increased from (31.56±7.22) g/L to (44.18±11.36)g/L, the difference was statistically significant (all P<0.05). All patients were followed up for at least 3 years. Shunt stenosis was detected in 5 patients (7.46%) with shunt expansion being performed, variceal bleeding in 2 patients (2.99%), ascites recurrence in 4 patients (5.97%) and hepatic encephalopathy in 2 patients (2.99%). No patients were diagnosed with hepatic cancer, and no patients died. Conclusion:DIPS was efficacious, safe and reliable to that BCS patients. It rapidly reduced portal venous pressure, relieved liver congestion, and restored liver morphology and liver function in these patients.
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ObjectiveTo investigate the clinical value of indocyanine green retention rate at 15 minutes (ICG-R15), Child-Turcotte-Pugh (CTP) class, and Model for End-Stage Liver Disease (MELD) score in predicting post-transjugular intrahepatic portosystemic shunt (TIPS) hepatic encephalopathy (HE) in liver cancer patients with portal hypertension. MethodsA retrospective analysis was performed for the clinical data of 95 liver cancer patients with portal hypertension who underwent TIPS in Department of Interventional Therapy in Beijing Shijitan Hospital from January 2015 to June 2017, and according to the presence or absence of HE after TIPS, they were divided into HE group with 24 patients and non-HE group with 71 patients. ICG-R15, CTP class, and MELD score were determined for all patients before surgery. The t-test was used for comparison of normally distributed continuous data between two groups, and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups; the chi-square test and the Fisher’s exact test were used for comparison of categorical data between two groups. Univariate and multivariate logistic regression analyses were used to investigate the risk factors for HE after TIPS, and the receiver operating characteristic (ROC) curve was used to analyze the value of ICG-R15, CTP class, and MELD score in predicting HE. ResultsThe incidence rate of HE was 25.2% (24/95) within 12 months after TIPS. The univariate analysis showed that stent location (P=0.021), ICG-R15 (P=0.005), and CTP class (P=0.040) were associated with HE after TIPS. The multivariate analysis showed that stent located in the right portal vein (OR=3.373, 95% CI: 2.346~5.103, P=0.010) and ICG-R15＞30% (OR=2.107, 95% CI: 1.331~3.212, P=0.036) were independent risk factors for HE after TIPS in liver cancer patients with portal hypertension. The ROC curve analysis showed that ICG-R15, MELD score, and CTP class had an area under the ROC curve of 0.659, 0.638, and 0.621, respectively, in predicting HE after TIPS. ConclusionICG-R15 has a certain clinical value in predicting HE after TIPS in liver cancer patients with portal hypertension.
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Transjugular intrahepatic portosystemic shunt (TIPS) has become an effective method for the treatment of portal hypertension. Although the use of polytetrafluoroethylene covered stents enhances shunt patency, hepatic encephalopathy remains a significant issue after TIPS. This article reviews the epidemiology, pathogenesis, pathogenic factors, and treatment of post-TIPS hepatic encephalopathy, so as to improve the understanding and awareness of this issue.
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Portal vein thrombosis (PVT) has become a common disease in clinical practice, and with the development of digital imaging, the detection rate of PVT has been increased significantly. PVT treatment is a multimodality therapy based on anticoagulant therapy and includes interventional treatment and surgical treatment. This article discusses the latest viewpoints of anticoagulant therapy for PVT and points out that the regimen of anticoagulant therapy should be selected based on patient′s conditions.
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Objective To investigate the clinical efficacy of transjugular intrahepatie portosystemie shunting (TIPS) for recurrent portal hypertension after liver transplantation.Methods The retrospective crosssectional study was conducted.The clinical data of 15 patients with recurrent portal hypertension after liver transplantation who underwent TIPS in the 9th School of Clinical Medicine between January 2008 to June 2016 were collected.Course of TIPS:the portal vein pressure was measured and varicose veins were embolized after puncture,cannulation and angiography.A balloon catheter with diameter of 7 mm or 8 mm was used to dilate the preshunt channel,and a covered stent or bare stent with a diameter of 7,8 or 10 mm was implanted to establish the shunt channel.Portal vein angiography was performed and the portal vein pressure was measured again.Observation indicators:(1) Surgical situations;(2) changes of portal vein pressure before and after TIPS;(3)follow-up and survival situations.Follow-up using outpatient examination was performed to record clinical symptoms at postoperative 1,3,6 and 12 months.Regular hepatic vascular ultrasonography was done at postoperative 1,3,6 and 12 months to detect patency of shunt.The follow-up period was up to June 2018.Measurement data with normal distribution were represented as (x) ±s and analyzed by the paired t test.Measurement data with skewed distribution were described as M (range).Count data were represented as percentage.Results (1) Surgical situations:all the 15 patients underwent successful TIPS,without any serious complications or death.Stent implantation situation:bare stent,covered stent and bare stent + covered stent were implanted in 4,8 and 3 patients,respectively.Among the 15 patients,7 mm,8 mm and 10 mm diameter shunt channel were established in 4,8 and 3 patients respectively.(2) Changes of portal vein pressure before and after TIPS:portal vein pressure of the 15 patients decreased from (34±8)mmHg (1 mmHg=0.133 kPa) to (21±7)mmHg before and after TIPS,with a statistically significant difference (t =7.07,P＜0.05).Portal vein pressure gradient decreased from (26± 9)mmHg to (12±5)mmHg before and after TIPS,with a statistically significant difference (t=6.43,P＜0.05).(3) Follow-up and survival situations:15 patients were followed up for 24.0-60.0 months,with a median follow-up time of 37.8 months.Main clinical symptoms:of 12 patients with gastrointestinal hemorrhage,3 had gastrointestinal rehemorrhage mainly due to portal vein pressure rising again caused by shunt restenosis or occlusion,9 had no gastrointestinal rehemorrhage.Of 5 patients with portal vein thrombosis,thrombus was disappeared basically in 3 patients and decreased obviously (no effect on blood flow) in 2 patients.Three patients with refractory ascites were effectively improved after TIPS,however,2 of them were recurred at postoperative 5 months.Postoperative restenosis or occlusion of shunt channel:among 15 patients,7 developed restenosis or occlusion of the shunt channel (including 4 with bare stents).Five of them underwent shunt recanalization and another 2 without special clinical symptoms had no treatment.Hepatic encephalopathy:6 of 15 patients including 1 with 7 nun shunt,3 with 8 mm shunt and 2 with 10 mm shunt developed hepatic encephalopathy,of which grade Ⅰ,Ⅱ,Ⅲ,and Ⅳ hepatic encephalopathy wee detected in 2,3,0 and 1 patients,respectively.Survival situations:of the 15 patients,1 died of hepatic failure at postoperative 6 months,3 were performed liver transplantation again at postoperative 3,8 and 14 months,respectively,11 survived more than 2 years with the longest survival time more than 6 years.Conclusion TIPS is safe and effective for recurrent portal hypertension after liver transplantation for patients who have not effective other treatment.
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Objective To discuss the relationship between discipline ranking and personnel rationality,and explore the problems of personnel development among all the disciplines and put forward further countermeasures.Methods A 3A general hospital in Beijing was targeted,and departments in it were divided into,in descending order of hospital regulations,key disciplines,developing-key disciplines,characteristic disciplines and general disciplines.To analyze the rationality of personnel,four dimensions as educational background structure,professional title structure,age structure and academic proficiency of department leader were adopted.Results The hospital had 52 departments in total,which were divided into key disciplines (7),developing-key disciplines (10),characteristic disciplines (6) and general disciplines (29).With the decline of the discipline level,the problem of the talent team was gradually increasing.The major problem of personnel among all the disciplines was that the proportion of senior staff was too high,so did the key disciplines and developing key disciplines.Age structure irrationalized was another major problem for developing-key disciplines.As for characteristic disciplines,the problems in personnel were even diversified,which included not only the irrational age structure and senior professional proportion,but also the fact that director of one third of these departments showed low academic proficiency.In general disciplines,all above four types of problems exited.Conclusions The rationality of the talent team is closely related to the level of the discipline.Problems in personnel varied among different disciplines,and countermeasures should be provided targeted at existing problems.
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Under the background of"medical education synergy", there are still some problems such as the poor treatment of graduate students, mismatching of between the master's degree point and standard-ized training base for resident, weakening of tutor guidance, and the lack of corresponding resident training bases of some secondary disciplines. Starting from the actual work experience, through the expansion of the coverage of resident training funds, integration of the resident training base with master's degree point in medical institutions, the establishment of tutor groups, and strengthening the cultivation of students' innova-tion and research ability, our hospital has improved the shortcomings of the current training work in many directions to improve the postgraduate education system of master degree in clinical medicine.
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Objective Hospital scientific research culture,as one of the most important components of hospital culture,plays a significant role in the connotative development of hospitals.Popularizing scientific research culture content via WeChat's public number helps promoting the development of science and technology in hospital.Methods This paper analyzes the content of hospital scientific research culture,summarize culture Information application of the WeChat's public number in different function plates.Results WeChat's public number has both advantages and disadvantages.Advantages are including large number of potential customers,efficient information dissemination,long information valid time,low information publishing cost and user friendly.There are also problems like lacking of interaction,insufficient reading,unprofessional managers,as well as some other issues.Conclusions WeChat's public number creates new ideas and directions to promote the development of scientific research culture.It can effectively strengthen the hospital scientific research cultural construction,Promote the development of hospital science and technology culture connotation.
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There is a high risk of re-stenosis after implanting blood vessels stent,the processes involves the transforming growth factor-β (TGF-β)-Smad signaling pathways,epithelial-mesenchymal transition (EMT) and so on.The function of TGF-β-Smad signal pathways and EMT in vascular stent re-stenosis and the relevant mechanism were reviewed in this paper.
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Objective To explore the feasibility of establishing a swine model of liver cirrhosis with portal hypertension by portal infusion of 80％ alcohol.Methods A total of 13 Guizhou miniature pigs were randomly divided into three groups,experiment group 1 (n=5),experiment group 2 (n=5) and control group (n=3).Experiment groups of pigs received portal infusion of 80％ alcohol in volumes of 5 ml in group 1,and 10 ml in group 2,and the pigs in control group received portal perfusion of saline in volumes of 10 ml.All animals were performed direct portal angiography,the portal vein pressures and diameter were also detected before,immediately and 6 weeks after the infusion.All animals underwent liver biopsies before and 6 hours,1-6 weeks after operation.And contrast-enhanced abdominal CT was performed before and 6 weeks after operation.All animals were dissected 6 weeks after operation,aud each leaf of liver specimens were performed histological examination.Results There was no statistically significant difference of the portal venous pressure and diameter before infusion and 6 weeks after infusion in the experiment group 1 and control group (all P＞0.05).In the experiment group 2,compared with pre infusion,the portal vein pressure and diameter were higher than those of immediately and 6 weeks after infusion (all P＜0.05).In both experiment group 1 and group 2,all pigs had developed into liver fibrosis,the METAVIR score of 2 pigs in group 1 and 5 pigs in group 2 respectively were up to grade 4.Conclusion Portal infusion of 80％ alcohol is more suitable for establishing a swine model of liver cirrhosis with portal hypertension.
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This article analyses the pre-management methods and measures for the youth science fund projects granted by the National Natural Science Foundation of China.Systematic procedures include mobilization,preliminary research preparation,professional training and counseling,modifying the application,form and content examination,which can improve efficiency of the National Natural Science Foundation of China youth science project management.
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Objective To establish an anatomical classification of chronic portal vein thrombosis (PVT) in order to guide the transjugular intrahepatic portasystemic shunt (TIPS) manipulation, and to analyze the correlation between anatomical classification of PVT and the occurrence of hepatic encephalopathy (HE) after TIPS. Methods During the period from June 2010 to June 2013 at authors’ hospital, TIPS with fluency covered stent was carried out in a total of 73 patients with chronic portal vein thrombosis. Based on the location of portal vein thrombosis, the anatomical classification of portal vein thrombosis (PVT-type) was initially established. The changes in portal vein pressure after TIPS were evaluated. The occurrence of HE at 15 days and at 3 and 6 months after TIPS in patients with different PVT-type was statistically analyzed. As the understanding of 0-phase minimal hepatic encephalopathy (MHE) was deepened, the authors added a subdivision to the 0-phase, including normal cognitive function state and minimal hepatic encephalopathy (MHE) into West - Haven grading to further precisely assess the hepatic encephalopathy. Using paired samples t-test, the changes of portal vein pressure after TIPS were evaluated. The grading of hepatic encephalopathy and the number of occurrence after TIPS were particularly recorded, the results were compared between groups at the same time and between the types at different times. Results The preoperative and postoperative portal vein pressure in type Ⅰ patients receiving TIPS therapy was (42.7 ± 9.6) and (35.0 ± 6.7) cm H2O respectively, the difference was statistically significant (t = 7.61, P <0.01);in typeⅡpatients it was(39.8 ± 5.5) and(31.0 ± 5.7) cm H2O respectively(t=17.2, P<0.01);in type Ⅲpatients it was (43.2 ± 5.8) and (32.4 ± 5.0) cm H2O respectively (t = 25.0, P < 0.01); and in type Ⅳpatients it was (43.0 ± 3.7) and (36.6 ± 6.6) cm H2O respectively (t = 4.26, P <0.01). The occurrence of HE 15 days after TIPS was mainly seen in patients with type Ⅳ , Ⅰ and Ⅲb. Phase Ⅰ hepatic encephalopathy mainly occurred in patients with PVT-type Ⅱa, Ⅲb and type Ⅰ. Phase Ⅱ hepatic encephalopathy occurred mainly in patients with PVT-type Ⅱb, Ⅲb and type Ⅰ. Three months after TIPS, the occurrence of MHE was mainly seen in patients of Ⅲa, Ⅱa and Ⅱc type. Phase Ⅰ hepatic encephalopathy mainly occurred in patients with Ⅲa, Ⅱb and Ⅳ type. Phase Ⅱ hepatic encephalopathy occurred mainly in patients with PVT-typeⅡa,Ⅱb andⅢb. Six months after TIPS, the occurrence of MHE was mainly seen in patients of type Ⅱa, Ⅱc and Ⅲb. Phase Ⅰ hepatic encephalopathy mainly occurred in patients with type Ⅱb, Ⅰ and Ⅲb. Phase Ⅱ hepatic encephalopathy occurred mainly in patients with typeⅡb,Ⅲb andⅠ. The HE condition lasted for longer time in patients withⅡb,Ⅲb andⅠtype. Conclusion The establishment of a rational anatomical classification for chronic portal vein thrombosis can effectively guide the clinical application of TIPS. The occurrence of postoperative hepatic encephalopathy is higher in patients with pure main portal vein thrombosis or superior mesenteric vein thrombosis.
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Objective To observe the efficacy of transjugular interventional therapy for patients with hepatic myelopathy after transjugular intrahepatic portosystemic shunt (TIPS).Methods Sixteen patients with hepatic myelopathy afte TIPS were treated with interventional therapy again.Four patients who were treated with drugs through shunt previously had poor prognosis,then the remaining 12 patients treated with current limited shunt had better prognosis,which were analyzed in this study.Activities of daily living were assessed by Barthel index,limb muscle strength scores were assessed by Lovette scoring system.The changes of liver function and portal vein pressure were analyzed by paired t-test,while other data such as serum ammonia level,Barthel index,Lovette scores before and after transjugular interventional therapy were compared by analysis of variance with repeated measurements.Results All the patients had no complication after operations.The liver function and portal vein pressure of 12 patients had no significan change before and after operation.Blood ammonia value were (77.9 ± 17.9) mmol/L after TIPS,(77.9 ± 14.8),(73.4 ± 21.5),(59.5 ± 14.5),(52.0 ± 16.5) mmol/L 1,3,6,12 months after current limited shunt.Compared with that of preoperation(F =6.45,P ＜0.05),it decreased significantly at the 6th and 12th month.Limb muscle strength scores were 2.1 ± 0.7 before current limited shunt,2.3 ± 0.8,3.1 ± 1.0,3.2 ± 1.1,2.8 ± 0.9 1,3,6,12 months after the operation.Compared with preoperation (F =4.97,P ＜ 0.05),muscle strength grading improved significantly at the 3rd,6th and 12th month.Activities of daily living Barthel index were 42.1 ± 10.5 before current limited shunt,47.1 ± 11.0,45.0 ± 8.8 3,6 months after the operation.Compared with preoperation (F =5.05,P ＜ 0.05),activities of daily living had improvement.There were 3,6,2,1 cases of hepatic encephalopathy of Ⅰ,Ⅱ,Ⅲ,Ⅳ stage after TIPS.Three months after current limited shunt there were 7,3,1,0 cases,while there were 8,1,1,0 cases 6 months after the operation.In other 4 patients treated with drugs,2 patients died of liver failure,one was lost to follow.Conclusions Interventional therapy can relieve symptoms of hepatic myelopathy.The operation is safe,effective,and helpful after TIPS treatment.
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Objective To evaluate the safety,effectiveness and clinical factors of re-intervention of transjugular intrahepatic porto-systemic shunt (TIPS).Methods A retrospective study of safety and longterm outcomes of TIPS was made in 771 patients from August 1994 to August 2010.The 625 patients had follow-up data.The patients who received TIPS once,twice,and more than twice were divided into group 1,group 2 and group 3,respectively.Clinical symptoms,survival rate and restenosis rate of each group were analyzed.Clinical influencing factors of re-intervention effect were discussed.Results The success rate of first intervention was 98.2％ (757/771),the death rate was 0.7％ (5/757) and severe complication rate was 2.5％ (19/757).The success rate of re-intervention was 98.7％ (457/463),no death and severe complications occurred.The restenosis rate in group 3 decreased significantly than group 1 ( x2 =7.908,P ＜0.05 ) in the first year of TIPS.The restenosis rates in group 2 and group 3 were lower than group 1 from 2 to 5 years of TIPS ( x2 values were 27.046,25.724,37.002 and 19.046,respectively,P ＜ 0.05 ). The survival rate in group 3 was higher than group 1 (x2 =9.114,P＜0.05)and group 2 was higher than group 1 ( x2 =4.929,P ＜ 0.05 ) in the first year of TIPS,while there was no statistical difference between group 2 and group 3 ( x2 =2.678,P ＞ 0.05).The patients in group 2 and group 3 also had higher survival rates than group 1 from 2 to 5 years of TIPS (x2 value were 41.314,26.920,13.692 and 6.713,respectively,P ＜ 0.05 ).19.4％ (79/406)of patients who received re-intervention had symptom recurrence and shunt stenosis or occlusion. 11.6％ (47/406) of patients had symptom recurrence with portal hypertension signs,62.8％ (255/406) had shunt stenosis or occlusion with portal hypertension signs.Conclusions Restenosis or occlusion of TIPS,symptom recurrence and portal hypertension signs were important factors for re-intervention.Re-intervention of TIPS was safe and effective,and could improve the survival rate of patients with TIPS.
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Radiologic examination was carried out on 114 subjects with chondromalacia ofpatella with follow up study for 1～17 years.All patients had a history of injury and/or overstrainedknee. The main early X-ray findings were :subchondral bone absorption and cystic degeneration ofpatella,sclerosis and haziness of the articular surface of patella, formation of small spur,subchon-dral bone absorption of articular surface of the femur,synovial thickening,patellar ligament widenedwith indistinct margin, hazy reticular appearance of subpatella fat, and thickened quadriceps femoraltendon etc. The X-ray manifestations of patella and adjacent tissue of patella became progressivelymore obvious but sparing the soft tissue with elapse of time.
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Purpose: Three kinds of embolizing agents, sodium mirrhuate, lipiodol and gelfoam were used together in treating hemangiomas of liver, pharynx, and spleen by embolizing the arteries. Materials and methods: 35 patients with hemangiomas, 30 cases in liver, 1 in spleen, and 4 in pharynx, were treated with embolizing hepatic artery, splenic artery, maxillary arterry, and face artery, respectively. Results: Tumors decreased 20%～90% in size, and none of then had continued to grow after the treatment for 3～36 months. At the same time, the suitable dose of embolizing agent according to the size of the tumor, the injection speed, the observation of the curative effect and the precaution of the embolization were also discussed, It showed that the effect of this method was better than using only one or two kinds of embolizing agents togethes resued in only slight complications. Conclusion: We think this method is safe and effective by combined with embolizing agents in treating hemaiomas of different organs and tissues.
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Objective To discuss the value of transcatheter artery embolization for the treatment of GI massive hemorrhage. Methods Seventy-eight GI massive bleeding cases underwent emergency angiography. Intraarterial embolization was performed in 86 arteries of the 78 patients. All patients were followed up for 1 to 10 years. Results Bleeding stopped immediately in 100% of the patients. Bleeding recurred in 16 cases from 48 hours to 37 monthes. Conclusion Arterial embolization for digestive tract bleeding is safe and effective during emergency angiography to buy a time for definite treatment for some patients.
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The development of innervations of sinoatrial node in 14 fetuses and two new borns was studied by Faworsky's silver impregnation technique and the results were summarized as follows:1. The ganglia and rich nerve fibers can be observed within the sinoatrial node in approximately 16-week old fetus. It was found that in 16 to 20-week old fetus there were more nerve ganglia within the node than in the subepicardial region.2. After 24 week, the nerve ganglia of the subepicardial region were divided in to two groups, i. e, the superficial and profund groups. Their number were larger than that of the peripheral ground around the artery in the node. The nerve bun-dles were thinker and richer.3. The nerve ganglionic cells with two or more nuclei were frequently found within sinoatrial node of fetuses and new borns but are rare in adults. The size of the nerve ganglion cells in the early stages of fetuses is various but they become more similar in size with the advancing age of the fetus towards maturity.