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Objective To summarize operation experiences in applying microcoils embolization for the treatment of intracranial wide-necked aneurysms using the low-profile visualized intraluminal stent support (LVIS) in elderly patients.Methods We reviewed data of 47 elderly patients (48 aneurysms) with intracranial wide-necked aneurysms treated with LVIS stent-assisted microcoils embolization.Results Forty-seven aneurysms were embolized successfully,one stent was withdrawn because its midpiece failed to stretch.Instant Raymond classifications evaluation after the surgery showed Grade Ⅰ in 52.1％ (25/48 aneurysms),Grade Ⅱ in 37.5％ (18/48 aneurysms),and Grade Ⅲ in 8.3 ％ (4/48 aneurysms).Besides,the effective rate of aneurysms embolization was 91.5 ％.During 3 to 12-month follow-up with digital subtraction angiography (DSA) in 36 patients (36 aneurysms),mRS was scored 0 (best effectiveness) in 28 cases,scored 1 in 4 cases,scored 2 in 3 cases,and scored 3 in 1 case,and the total favorable rate was 97％.Conclusions LVIS stent-assisted microcoils embolization for the treatment of intracranial wide-necked aneurysms in elderly patients may avoid or reduce the incidence of complication.
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Objective To investigate the perioperative complications and therapeutic effects of balloon-assisted coiling (BAC) and stent-assisted coiling (SAC) in patients with ruptured intracranial aneurysms in the acute phase. Methods Totally 91 patients with 91 intracranial ruptured aneurysms were treated with BAC or SAC in our hospital between January 2014 and December 2016. Among them, 37 patients were treated with BAC and 54 patients with SAC respectively. Of the two groups, the position distribution and shape of aneurysms, and the complications after procedures and the therapeutic effects were summarized and evaluated retrospectively using chi-square test. Results The width of the aneurysm neck was narrower in the BAC-treated group compared to the SAC-treated group (3.31±1.63 mm vs. 4.35±2.10 mm, P=0.01). The aneurysm body/neck ratio (B/N) was lower in the BAC-treated group than in the SAC-treated group (1.64 ± 0.46 vs. 1.35±0.66, P=0.025). The recurrence rate was higher in the BAC-treated group than that in the SAC-treated group (18.9％ vs. 0.9％, P=0.005). There was no statistical difference in perioperative complication in both the BAC-treated group and SAC-treated group. However, 2 patients died due to the relative postoperative intracranial bleeding in the SAC-treated group. Better outcomes (Modified Rankin Score, mRS, 0-2) were achieved in the BAC-treated group compared to the SAC-treated group (94.6％ vs. 88.9％, P=0.028) at the follow-up visit. Conclusions These findings suggested that there is no difference between the BAC-treated group and the SAC-treated group in the risk of complication. BAC can achieve a better prognosis,but it is more prone to relapse. The SAC method was more appropriate for wider neck aneurysms. It was also an option to coiling the aneurysm in BAC in acute phase firstly, followed by additional treatment in SAC during the follow-up period.
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Objective To investigate the distribution of in-stent recurrent stenosis (1RS) after balloon-angioplasty and stenting in elderly cerebral ischemic patient and its correlative factors.Methods Totally 158 elderly cerebral ischemic patients with extra-and/or intracranial artery stenosis were treated with 172 stents in our hospital.The inhibition of platelet function was assessed by using the thrombus elasticity chart system in perioperative period,and the anti-platelet agents were adjusted correspondingly.150 patients were followed up by digital subtraction angiography (DSA) and the other 8 patients were followed up by CT angiography,during an average follow-up duration of 8.3 months.Results There were 11 (6.4％) IRS lesions,among which 10 lesions were at the vertebral artery origin and 1 lesion was at common carotid artery bifurcation.23.8％ of IRS happened after vertebral artery origin stenting,and all in-stent recurrent stenosis were in the origin of non-dominant vertebral artery,whose IRS rate was 66.7％.Conclusions IRS are more common found in vertebral artery origin than in other parts of vertebral artery and are more common found in nondominant side than in dominant side.
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The present residents training for ultrasound departments depends mostly on poorlyscheduled rotation and clinical clerkship,with repeated and obsolete subjects in their training.The authors identified these setbacks and such characteristics as complication of ultrasound medicine,complex and variable ultrasonic scan technique,and the high threshold for beginners.In view of this,the authors adopted the tutorial system training mode for cultivating the residents in their medical care,teaching,research and foreign language competencies.A questionnaire survey of 44 residents so trained evaluated outcomes of the mode,with constructive suggestions raised on expansion of the training base,improvement of teachers’competency and reduction of trainees' workload.
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Objective To investigate the incidence,sonographic appearance of the anatomic variation of carpal tunnel median nerve and its accompanying structures in healthy volunteers and explore the value of this variation in carpal tunnel syndrome.Methods A total of 360 hands of 180 healthy volunteers were included in the study.The full course of the median nerve in the forearm and carpal tunnel was examined with high-frequency ultrasound.The median nerve was first located in cross section at wrist and then with continuous cross-sectional scanning to observe the the full course of the median nerve in the forearm and carpal tunnel with high-frequency ultrasound.Results Anatomic variation of carpal tunnel median nerve and its accompanying structures were observed:① High division median nerve were found in 2 wrists (0.56 ％) ;②Bifid median nerve were found in 17 wrists (4.72％) ;③Persistent median artery were found in 22 wrists (6.11％),and 2 wrists (0.56％) were also found accompanied vein.Aanatomic variation of carpal tunnel median nerve accompanied with persistent median artery were observed in 16 wrists (4.44 ％).Conclusions High-frequency ultrasound was sensitive to diagnose the anatomic variation of carpal tunnel median nerve and its accompanying structures.Recognition of these variations can help us to make correct diagnosis of carpal tunnel syndrome.
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Objective To evaluate the value of ultrasound in diagnosing shoulder lesions.Methods Ultrasound images were obtained by two museuloskeletal sonologists in 111 patients suspected of having rotator cuff and non-rotator cuff lesions which were confirmed by following arthroscopic surgery.Results The arthroscopic findings demonstrated that there were two or more lesions in one patient in majority of patients,included 67 supraspinous tendon tears,5 infraspinous or subscapular tendon injuries,10 calcific tendonosis,2suprascapular notch cysts,34 subaeromial bursitis,1 intrabursa loose body,13 biceps longus tendon dislocation or disruption,and 21 lahrum injury.The accuracy of ultrasonogrpahy was 92% in diagnosis of supraspinous tendons tear,97% in subscapular tendon inj uries,96% in calcific tendonitis,1 00% in suprascapular notch cysts,88% in subacromial bursitis,100% in biceps longus tendon dislocation or disruption,and 81% in labrum injury.Conclusions Ultrasound can evaluate shoulder lesions effectively.
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Objective To probe the value of absent or reversed diastolic flow in hepatic artery shown by Doppler sonography of recently transplanted liver in predicting subsequent hepatic artery thrombosis.Methods The records of 54 liver transplantations performed were retrospectively reviewed.The first Doppler study of every case was done within 24 h after transplantation and subsequently reviewed.Findings were categoried into one of three patterns: forward flow,no flow and reversed flow throughout diastole.Meantime,the flow status of portal vein of every case was studied by Doppler sonography.Results Of 54 liver transplants, 12 had aberrant diastolic flow in the hepatic artery after liver transplantation.Four had reversed flow and 8 showed no flow in diastole.In this group of 12 transplants,hepatic artery thrombosis was not developed.Conclusions Reversed or absent diastolic flow in hepatic artery of a recently transplanted liver has no correlation with subsequent hepatic artery thrombosis.
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By analyzing the basic line of medical ethics,this paper points out the collapse of basic line of medical ethics is due to the lack of people-oriented spirit in medical activities.Hospitals and medical staff should build up people-oriented spirit and conscience,strengthen the sense of honor and humiliation,thus to prevent the recollapse of the basic line of medical ethics and build up a harmonious physician-patient relationship.This project is significant in conducting the educational program of social glory and humiliation sense.
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Objective To assess the effectiveness of cerebral hemodynamical changes after carotid endarterectomy (CEA).Methods Eleven patients with symptomatic internal carotid arterial stenosis were selected.Before and after CEA,the peak systolic velocity,blood flow volume in ipsilateral internal carotid artery and the peak systolic velocity in bilateral cerebral middle artery were measured by color Doppler flow imaging (CDFI) and transcranial Doppler (TCD).Also collateral circulations via the circle of Willis and the ophthalmic artery were detected.Results After operation,the systolic peak velocity in the ispilateal internal carotid arteries decreased [( 291.70 ? 65.2 5)cm/s vs ( 100.85 ? 35.68 ) cm/s,P