ABSTRACT
Objective:To investigate the safety and effect of transcatheter arterial chemoembolization (TACE) combined with radiofrequency ablation (RFA) and sorafenib on large hepatocellular carcinoma (HCC) patients treatment.Methods:From Jan 2012 to Dec 2017, 36 patients (Male: 33, Female: 3, average age: 51.8) with large HCC lesions(5-7 cm) received TACE plus with RFA and sorafenib in the Third Affiliated Hospital of Sun Yat-sen University. Efficacy was evaluated after TACE. Each patient was received follow-up after RFA procedure. The occurrence rate of complications and overall survival (OS) were recorded. Log-rank univariate analysis was used to analyze the OS data.Results:The median TACE time was 4, and the RFA time was (1.7±0.7) . Mean duration time of sorafenib administration was (37.7±28.8) months. Adverse events of sorafenib: 26(72.2%) hand-foot skin reaction, 6(16.7%) hypertension, 22(61.1%) diarrhea, 17(47.2%) alopecia, 3(8.3%) oral ulcer and 1(2.8%) gastrointestinal hemorrhage. Median OS was 63.0 months, and 1-year, 3-year and 5-year survival rate was 100%, 72.7% and 52.6%. The cumulative survival rate of patients taking whole course of sorafenib ( n=21) was better than that of patients taking remedial ( n=15); the cumulative survival rate of patients with alpha fetal protein (AFP) <200 μg/L ( n=26) before treatment was better than ≥200 μg/L ( n=10); the cumulative survival rate of patients with good TACE response ( n=19) was better than that of patients with no response ( n=17), and the differences were statistically significant (all P<0.05). Conclusions:TACE plus with RFA and sorafenib are safe and effective for large HCC patients with 5-7 cm lesions and this treatment might improve OS. The whole-course sorafenib, lower base AFP value (<200 μg/L) and good TACE response were considered as the good factors for the combination therapy in large HCC patients.
ABSTRACT
【Objective】 To investigate the epidemiology of HTLV by conducting HTLV nucleic acid detection among voluntary blood donors, so as to provide basis for the decision making of blood screening strategy. 【Methods】 The HTLV blood nucleic acid(NAT) screening platform was established based on the existing NAT for HBV / HCV / HIV screening. HTLV (type 1 + 2) detection was carried out in 5 368 blood donors, and the results were analyzed. 【Results】 No NAT-yielding of HTLV- 1, -2 type was found in a total of 5 368 voluntary blood donor from January to August 2019. 【Conclusion】 Qianxinan, currently, is very low epidemic or non epidemic as none of HTLV infections was found among blood donors and no significant differences in the epidemiology of HTLV were notable between the counties and cities. It, however, still needs further investigation in the future.
ABSTRACT
Objective To study the treatment outcomes using transcatheter arterial chemoemboliza tion (TACE) followed by hepatic resection (HR) in patients with BCLC stage B hepatocellular carcinoma (HCC).Methods The clinical data of 46 patients with intermediate stage HCC in the Third Affiliated Hospital of Sun Yat-sen University from Jan.2004 to Jul.2013 were analyzed retrospectively.The baseline characteristics of these 46 patients were recorded.The levels of serum aspartate transaminase (AST),ala nine aminotransferase (ALT),total bilirubin (TBil),and albumin (Alb),and the prothrombin time (PT) at 1 week and 1 month after HR were compared with those at the baseline.The overall survival (OS) and progression-free survival (PFS) were analyzed by the Kaplan-Meier method.The effect on PFS by the changes in the alpha-fetal protein level and the modified Response Evaluation Criteria In Solid Tumors (mRECIST) after TACE were analyzed using the log-rank test.Results The number of cycles of TACE given before HR was 1.7 ± 1.1.The mean time interval between TACE and HR was 3.0 ± 3.2 months.The levels of serum AST,ALT,TBil,Alb and PT at 1 week after HR were significantly different from the baseline levels (P ＜ 0.05),while those levels at 1 months after HR showed no significant difference from the baseline levels (P＞0.05).The mean OS was 72.1 ±6.0 (95％ CI 60.36 ～83.86) months.The median PFS was 46.0 (95％ CI:42.60～49.40) months.Using the log-rank test,the decrease in AFP (P ＜ 0.001) and the improvement in mRECIST (CR + PR) (P ＜ 0.001) after TACE were significantly associated with better PFS.Conclusions HR after TACE was safe for patients with BCLC stage B HCC and might prolong the PFS and OS.Decreases in AFP level and improvement in mRECIST (CR + PR) after TACE were factors they could be used to predict the survival outcomes of HR.
ABSTRACT
Objective To investigate the efficacy and safety of percutanous transhepatic intrahepatic portosystemic shunt(PTIPS)for chronic portal vein occlusion and cavernous transformation with symptomatic portal hypertension.Methods The clinical and imaging data of 38 patients with chronic portal vein occlusion and cavernous transformation with symptomatic portal hypertension, who received PTIPS in our hospital from November 2009 to June 2016,were analyzed retrospectively.The differences of the portosystemic pressure gradient(PPG)measured before and after PTIPS procedure was analyzed by a paired samples t-test. All the patients were followed up and the curative effect and operation-correlated complications were observed.Results The PTIPS procedure was technically successful in 36 patients.The other two patients with unsuccessful PTIPS underwent medical treatment,and one of them died of recurrent variceal bleeding 25 months later. Effective portal decompression and free antegrade shunt flow were achieved in 36 patients with successful PTIPS.And the mean PPG was decreased from(25.2±2.9)to(13.2± 1.3) mmHg (1 mmHg=0.133 kPa) before and after PTIPS respectively and the difference was statistically significant(P<0.05).During the procedure,arterial hemorrhage occurred in two patients who subsequently underwent embolization. Biliary injury occurred in one case and percutanous transhepatic biliary drainage (PTBD)was then performed.The mean follow-up period of the 36 patients was(26.7±10.4)months(range from 3.0 to 74.0 months).Hepatic encephalopathy appeared in 4 cases,among which,3 patients recovered after receiving medical treatment, while 1 patient experienced Grade 3 hepatic encephalopathy and recovered after implanting a smaller cover-stent.Shunt dysfunction occurred in 10 cases,of which 8 cases recovered after shunt revision with stent implantation or ballon angioplasty, while 2 cases underwent anticoagulation by warfarin only. During follow-up period, 7 patients died of liver failure(n=4), hepatic cellular carcinoma(n=1), recurrent varicose vein bleeding(n=1), and renal failure(n=1). The other patients remained asymptomatic and shunt patency. Conclusions PTIPS is both safe and effective for the treatment of symptomatic portal hypertension caused by chronic portal vein occlusion and cavernous transformation.The technical success rate is high,and the short-term curative effect is satisfied.
ABSTRACT
Objective To study the feasibility and efficacy of percutaneous transhepatic intrahepatic portosystemic shunt (PTIPS) in patients with portal hypertension due to chronic portal vein occlusion after splenectomy.Methods 27 patients who had portal hypertension due to chronic portal vein occlusion after splenectomy underwent PTIPS between December 2010 and March 2015.These patients were enrolled in this retrospective study.The success rates,efficacy,and complications were evaluated.Significance in the differences in the portosystemic pressure gradient (PPG) as measured before and after PTIPS procedure was assessed.Results PTIPS was successfully carried out in 25 patients but failed in 2.No fatal procedural complications were observed.The mean PPG dropped from (22.3 ± 5.7) mmHg to (12.4 ± 3.1) mmHg after successful PTIPS (1 mmHg =0.133 kPa,P ＜0.05).The median follow-up in the 25 patients with successful PTIPS were 22 months and there were 3 (12.0％) deaths from liver failure due to severe cirrhosis,and 1 death (4.0％) from stroke during the follow-up period.Shunt dysfunction happened in 4 (16.0％) patients.The original symptoms reoccurred in 2 patients (8.0％) and the remaining patients were diagnosed by routine CT or US examination.Three patients recovered after shunt revision with stent implantation or balloon angioplasty,while one patient refused any further therapy except oral medication.This patient suffered from the first episode of rebleeding 36 months after PTIPS.Hepatic encephalopathy developed in 2 (8.0％) patients,1 patient recovered after medical treatment,while the other who developed Grade 3 hepatic encephalopathy recovered after implanting a smaller cover stent.The remaining patients were asymptomatic with patent shunts.Conclusion PTIPS was a feasible,safe,and efficacious treatment for portal hypertension due to chronic portal vein occlusion after splenectomy.
ABSTRACT
Objective To investigate the technique,efficacy,and safety of percutaneous interventional treatments for biliary complications (BC) after liver transplantation (LT).Methods The clinical and imaging data of 127 patients with BC after LT,who received percutaneous interventional treatments in the Third Affiliated Hospital of Sun Yat-sen University from January 2006 to December 2015,were analyzed retrospectively.On the basis of the cholangiographic appearance,patients were classified into 5 groups:biliary leakage group (n =11),anastomotic biliary strictures group (n=28),hilar biliary strictures group (n =30),multifocal biliary strictures group (n =51),and bilomas group (n =7).The modality of interventional treatments was percutanous transhepatic biliary drainage (PTBD),PTBD combined with balloon dilation,PTBD combined with balloon dilation and stent implantation.The methods of biliary drainage included external drainage and external-internal drainage.All the patients were followed up after treatment.The curative effect and operation-correlated complications were observed.Results The first successful rate of PTBD was 97.6％ (124/ 127).The total curative rate,improvement rate and inefficacy rate of interventional treatments were 37.8％ (48/127),44.9％ (57/127) and 17.3％ (22/127) respectively.In biliary leakage group,all the patients were cured by percutaneous interventional treatments with the curative rate being 100％.In anastomotic biliary strictures group,the cure and improvement rates were 64.3％ (18/28) and 35.7％ (10/28) respectively.The efficacy rate was 100％ (28/28).In hilar biliary strictures group,the cure,improvement and inefficacy rates were 40％ (12/30),53.3％ (16/30) and 6.7％ (2/30) respectively.The efficacy rate was 93.3％ (28/30).In multifocal biliary strictures group,the cure,improvement and inefficacy rates were 13.7％ (7/51),54.9％ (28/51) and 31.4％ (16/51) respectively.The efficacy rate was 68.6％ (35/51).In bilomas group,3 cases (3/7) obtained improvement and treatment of 4 cases was inefficative.The efficacy was the best for the patients with bilary leakage,and it was the worst for the patient with bilomas (P＜0.001).The main operation-correlated complication was bile tract infection during drainage.The rates of bile tract infection were 32.4％ (34/105) and 81.8％ (18/22) in patients with external drainage and external-internal drainage,respectively.There was statistically significant difference between these two items (P＜ 0.001).Conclusion PTBD combined with balloon dilation and biliary stent implantation is a safe and effective therapeutic modality for BC after LT,which can improve patients' clinical symptoms,improve patients' quality of life.The patients with bilomas should be treated by retransplantation as soon as possible.The biliary external drainage can decrease the rate of biliary tract infection significantly.
ABSTRACT
Objective To evaluate combination multiple interventional therapies for acute lower extremity deep venous thrombosis (DVT).Methods From January 2008 to October 2014,96 patients with acute unilateral proximal or mixed DVT received interventional treatments including 74 DVT cases of the left lower extremity,and 22 patients in the right.Procedures undertaken included catheter-directed thrombolysis (CDT) only (n =7),CDT combined with thrombolysis (n =89),balloon angioplasty (n =32),and stent implantation (n =6).Results The mean circumference difference between the normal and affected thighs dicreased from (6.7 ± 1.8) cm to (0.8 ± 0.3) cm,t =13.48,P ＜ 0.001.That between the normal and affected calves decreased from (5.9 ± 1.6)cm to (0.7 ±0.4)cm,t =12.84,P ＜0.001.After intervention the Porter's score reduced from (9.7 ± 2.4) points to (1.1 ± 0.6) points,t =15.46,P ＜0.001,and the venous patency rate was (90 ± 8)％.Conclusion CDT combined with thrombolysis through dorsal vein,PTA,and stent implantation is a safe and effective therapeutic modality for acute lower extremity DVT.
ABSTRACT
Objective To evaluate the therapeutic effect of transarterial chemoembolization (TACE) combined with CT-guided 125I seed implantation in treating hepatocellular carcinoma (HCC) complicated by portal vein tumor thrombus(PVTT), and to discuss the technical points. Methods A total of 48 HCC patients with PVTT were enrolled in this study. TACE combined with CT-guided 125I seed implantation was carried out in all 48 patients. Based on the sites of PVTT, the lesions were classified into type A (PVTT within main portal vein), type B(PVTT within level-1 portal branch) and type C(PVTT within level-2 or more distal portal branch). According to whether the 125I seeds were directly implanted into the PVTT or not, the patients were divided into direct in-tumor thrombus implantation group (group A) and around tumor thrombus implantation group (group B; the 125I seeds were implanted in the liver parenchyma or in tumor tissue around the tumor thrombus within 1.7 cm region). The tumor thrombus control rate(TTCR), the disease control rate(DCR), the time to progress(TTP) and the overall survival rate of patients(OS) were determined, and the results were compared among different types and groups. Results TACE combined with CT-guided 125I seed implantation was successfully accomplished in all 48 patients. The median OS of type A, B and C was 8, 11.5 and 15 months respectively(P=0.003);the TTCR of type A, B and C was 61.5%, 70.8%and 72.7%respectively(P=0.548); the DCR of type A, B and C was 69.2%, 75%and 81.8% respectively (P=0.483); the median TTP of type A, B and C was 4.5, 8 and 11 months respectively(P=0.030);the median TTP of intra-hepatic tumor of type A, B and C was 5, 9 and 9.5 months respectively(P=0.012). The median OS in group A and group B was 10 and 11.5 months respectively (P=0.239); the TTCR in group A and group B was 69.2% and 68.2%respectively(P=0.591); the DCR of intra-hepatic tumor in group A and group B was 73.1% and 77.3%respectively(P=0.502); the median TTP of tumor thrombus in group A and group B was 7 and 10 months respectively(P=0.276); and the median TTP of intra-hepatic tumor in group A and group B was 8 and 9.5 months respectively(P=0.089). Conclusion For the treatment of hepatocellular carcinoma complicated by portal vein tumor thrombus, TACE combined with CT-guided 125I seed implantation can effectively control the progress of both the tumor thrombus and the intra- hepatic tumor and prolong patient’s survival time. Implantation of 125I seeds into the portal vein tumor thrombus and implantation of 125I seeds into the liver parenchyma around the tumor thrombus have the same therapeutic results. (J Intervent Radiol, 2015, 24:488-493)
ABSTRACT
Objective To investigate the safety and efficacy of interventional treatment for ischemic-type biliary lesion (ITBL)after liver transplantation (LT). Methods The clinical and imaging data of 76 patients with ITBL after LT,who received interventional treatment in the Department of Interventional Vascular Radiology of the Third Affiliated Hospital of Sun Yat-sen University from January 2006 to February 2014,were retrospectively analyzed. On the basis of the cholangiographic appearance,patients were classified into 3 groups:hilar biliary stricture group (n=28),multifocal biliary stricture group (n=42),and biloma group (n=6). The modalities of interventional treatment were percutanous transhepatic biliary drainage (PTBD), PTBD combined with balloon dilation,PTBD combined with balloon dilation and plastic stent implantation. The methods of biliary drainage included external drainage and external-internal drainage. All the patients were followed up after treatment. The curative effect and biliary complication was observed. Results The first successful rate of PTBD was 97% (74/76). The total curative rate,improvement rate and ineffective rate of interventional treatment were 21% (16/76),51% (39/76)and 28% (21/76). In hilar biliary stricture group,the cure,improvement and inefficacy rates were 36% (10/28),57% (16/28)and 7% (2/28).The efficacy rate was 93% (22/28 ). In multifocal biliary stricture group,the cure,improvement and inefficacy rates were 14% (6/42),50% (21/42)and 36% (15/42). The efficacy rate was 64% (27/42). In biloma group,2 cases (2/6)were cured and treatment of4 cases was ineffective. The efficacy ofhilar biliary stricture group was better than that of multifocal biliary stricture group (P<0.05 ). The efficacy of multifocal biliary stricture group was better than that of biloma group (P <0.001 ). The main biliary complication was biliary tract infection during drainage. The rates of bile tract infections were 20% (13/64) and 67% (8/12)in patients with external drainage and external-internal drainage,respectively. There was significant difference between these two items (P <0.001 ). Conclusions PTBD is a safe and effective therapeutic modality for ITBL after LT,which combined with balloon dilation and biliary stent implantation can improve patients’clinical symptoms,elevate patients’quality of life. The biliary external drainage can decrease the rate of biliary tract infection significantly.
ABSTRACT
Objective To describe the technique, efficacy, and safety of percutaneous interventional therapy for anastomotic biliary strictures after orthotopic liver transplantation (OLT).Methods From May 2004 to December 2009, 25 patients with anastomotic biliary strictures afte OLT were enrolled in our study. The modalities of biliary drainage included external drainage in 22patients, and external-internal drainage in 3 patients who underwent re-transplantation. All patients accepted percutaneous interventional therapy in our hospital, including single PTBD in 4 patients,PTBD combined with balloon dilation in 14 patients, balloon dilation and plastic stent implantation in 5 patients, balloon dilation and metallic stent implantation in 2 patients. The drainage catheters were exchanged every 1 to 3 months. Results The success rate of PTBD was 100%. Of the all 25patients, 15 (60 %) patients were cured, and 10 (40 %) patients were improved. The effective rate was 100 %. The drainage catheters failed to pass through the narrow bile duct when initial PTBD in 7 patients, and success was achieved in 3 patients by operation again after biliary drainage for one week.In the other 4 patients, anastomotic bile ducts were occluded, which was confirmed by cholangiography after biliary drainage for 4 to 8 weeks. The rate of biliary tract infection was 24 % (6/25). No serious procedure-related complications occurred in the all 25 patients. Conclusion PTBD combined with balloon dilation and biliary stenting is a effective and safe therapeutic modality for anastomotic biliary strictures after OLT, which can improve the patients' clinical symptoms and elevate patients' quality of life. To avoid bile duct occlusion, the drainage catheters should be passed through the narrow segments of bile duct when initial PTBD.
ABSTRACT
Hepatic venous outflow obstruction is a severe complication after liver transplantation, often occurs after living donor liver transplantation (LDLT). In this article, the clinical and imaging data of two patients with hepatic venous outflow obstruction after LDLT were analyzed retrospectively, and the related literatures were reviewed to explore the diagnosis and the interventional therapy of this complication. Hepatic venous outflow obstruction can be confirmed with percutaneous transhepatic venography. Percutaneous interventional managements, including balloon angioplasty and stent implantation are safe, easy and effective for the treatment of hepatic venous outflow obstruction after adult-to-adult living donor liver transplantation (A-A LDLT).
ABSTRACT
Objective To investigate the methods and efficacy of percutaneous transhepatic biliary drainage(PTBD)for the treatment of bile duct fistula related to orthotopic liver transplantation (OLT).Methods Seven patients(the median age was 40,from 25 to 56 years)with bile duct fistula related to OLT from January 2007 to May 2008 were analyzed retrospectively,including 6 receptors of OLT and 1 donor of living-donor liver tansplantation(LDLT),with anastomotic bile duct fistula and peripheral duct fistula of resection surface respectively.Of the 6 OLT receptors,hepatic artery stenosis occurred in 2 cases.All the patients underwent external biliary drainage(namely,with the drain tip in a pre-leak site).When the orificium fistulae was occluded and no bile drained from the drainage tube of abdominal cavity,the patients were diagnosed as cured.Results The mean output of the drainage tube was 350 ml/day(range 180-450 ml/day).After PTBD for 21 to 87 days(the median time was 62 days),the bile duct fistula was cured in all the 7 patients.During 93-675 days(the median time was 124 days)of follow-up,4 cases survived with normal level of health,2 cases gave up treatment for multiple-organ failure and 1 case died of hepatic function failure after hepatoma recurred.Biliary tract infection was occurred in 1 patient during PTBD.Conclusion PTBD could be proposed as a safe,effective and convenient method for treantment of bile duct fistula even in patients with poor general condition.
ABSTRACT
Objective To evaluate the feasibility of percutaneous transsplenic portal vein catheterization (PTSPC). Methods Thirty patients with portal hypertension underwent gastroesophageal variceal embolization via PTSPC route, 2 of which simultaneously underwent portal vein stenting. This study included the patients with portal venous obstruction ( tumor embolus or thrombus) or the patients with serious liver atrophy caused by liver cirrhosis. The patients who had severe coagulation insufficiency (with prothrombin time ＞ 20 s) were excluded. Of the 30 patients, 17 had primary hepatocellular carcinoma with main portal venous tumor embolus, 13 had cirrhosis with severe liver atrophy and(or) slight or moderate ascite. Before this study, all of 30 patients had a history of variceal bleeding, and 16 patients had a normal coagulation level, 10 patients had a mildly prolonged prothrombin time (14-17 s), 4 patients had a moderately prolonged prothrombin time (18-20 s). All of 30 patients underwent upper abdomen CT enhanced scanning before this procedure, and the site, direction, and depth of splenic vein branch puncture were decided by CT images. The technology of PTSPC, procedure-related complications, and its clinical application were retrospectively analyzed. Results PTSPC was performed successfully in 28 of 30 patients. Two cases failed because of a small intrasplenic vein. Procedure-related complications occurred in 6 patients (20. 0% ), which had decrease of hemoglobin concentration ( 15-50 g/L). Four of them needed blood transfusion. In the six patients, one patient (3.3%) with abdominal cavity hemorrhage had a serious drop of blood pressure 2 hours after procedure, whose clinical symptoms were relieved after four units of packed RBC and a great quantity of fluid were transfused. Twenty-eight patients whose PTSPC were successfullyperformed underwent variceal embolization, 2 of them were placed with portal vein covered stents. During a median follow-up period of 6 months (range: one to forty-two months), 14 patients died of hepatocellular carcinoma 1 to 12 months after procedure, and 2 patients died of hepatic failure caused by liver cirrhosis at fourteen months and twenty-three months after procedure, respectively. Variceal rebleeding was observed in 4 patients, the cumulative rebleeding rate at 1 year was 14.3%. Conclusion PTSPC is a feasible procedure, which provides a useful route for endovascular treatment of portal vein. However, hemorrhage at the puncture site after procedure should be noticed.
ABSTRACT
Objective To determine the timing for therapy and efficacy for different types of hepatic artery stenosis (HAS) after orthotopic liver transplantation(OLT). Methods From October 2003 to May 2007, a total of 21 patients had hepatic artery stenosis after OLT in this hospital. Of the 21 patients, 19 underwent stent placement in their narrowed hepatic arteries and 2 were regularly followed up. Liver function, clinical outcomes, and the hepatic artery potency were reviewed. Results The occurring rate of HAS was 3.43% (21/613) and its median time of diagnosis was 146 days (range, 2-515 days). Six patients with early HAS were treated with interventions and 2 of them died.For the 4 surviving patients, 2 received retransplantation. For the 15 patients with late HAS, 13 were treated with interventions and 4 of them died. Two patients received retransplantation. Seven surviving patients had abnormality in liver function. Another 2 patients had normal liver function because of hepatic portal form compensatory circulation. Conclusion The presence of ischemic bile duct lesion and whether or not favourable compensatory circulation exists or not should be considered before individualized therapeutic regimens adopted according to postoperative HAS types.
ABSTRACT
Objective To study the safety and effect of interventional treatment for arteriesclerotic obliterations of iliaco-fermoral artery via radial artery retrospectively.Methods Sixteen cages were treated with interventional procedare via radial artery.The duration of disease was from 3 days to 2 years.All cases presented with rest pain and intermittent claudicating(with distance less than 500 m).Unilateral lesions were found in 9 cases.and bilateral lesions in 7 cases.Iliaco-femoral arteries were obliterated completely in 6 cases.while the other ten cases had arterial stenesis more than 75%.After visualization of obliterative artery.urokinase was administrated consecutively from catheter indweUed in or above thrombus.Transcatheter thrombolysis would be cancelled if the therapeutic effect wag negligible after using umkinase for 72 hours.After thrombolysis.the balloon angioplasty and the stent implantation were performed in the cases with residual stenesis more than 50%. In all of 16 cases,5 caseg underwent continuous intraarterial thrombolysis only.11 cases received balloon angioplasty and/or stent implantation additionally.The ankle/braehial index(ABI)post-treatment and pre-treatment was analyzed.Results The duration of transcatheter thrombolysis was 3.0-15.0 days,averaged(8.4±2.9)days.The obliterative arteries were recanalized in 15 cases.The symptoms of rest pain disappeared in all cases.while intermittent claudicating was still present in 4 cases,but the claudicating distance increased significantly(92.50±60.21 and 625.00±84.26 m for pre-and post-operation respectively).The ABl was 0.63-1.10(0.91±0.12)for post-treatment and 0-4).57(0.32±0.14)for pre-treatment respectively(t=21.73,P＜0.01).During 6-24 months' follow-up,restenosis occurred in 1 case,which was treated successfully once again after halloon angioplasty.There was no serious complication related to the procedure.Conclusion It is safe and effective to apply continuous thrombolysis combined with balloon angioplasty and stent implantation to treat iliacofemoral artery obliteration interventionally via radial arterv.
ABSTRACT
Objective To investigate the prognosis and prognostic risk factors of hepatic artery complications after orthotopic liver transplantation (OLT) treated with the interventional techniques.Methods The clinical data of 21 patients with hepatic artery complication after liver transplantation receiving thrombolysis, PTA, and stent placement in our institute from November 2003 to April 2007 were retrospectively analyzed. Based on the prognosis of grafts, 21 patients were divided into poor-prognosis group and non-poor-prognosis group. Fifteen variables (including biliary complication, hepatic artery restenosis,early or late artery complication, and so on) were analyzed in both groups with binary logistic regression analysis to screen out the risk factors related to prognosis of percutaneous interventional treatment for hepatic artery complications after OLT. Results Twenty-one patients were followed for mean 436 days, median 464 days (3-1037 days). The poor-prognosis group included 11 patients (5 cases received retransplantation, and 6 died). The mean survival time of grafts in poor-prognosis group was 191 days, and median survival time was 73 days (3-616 days). The mean survival time of grafts in non-poor-prognosis group which included 10 patients was 706 days, and median survival time was 692 days (245-1037 days).Univariate analysis showed there were significant difference in biliary complication, total bilirubin and indirect bilirubin between the two groups. The binary logistic regression analysis showed the risk factor related to prognosis was with biliary complication before the interventional management (P = 0.027, OR =22.818). Conclusion Biliary complication before interventional management is the risk factor related to poor prognosis of patients with hepatic artery stenosis or thrombisis receiving interventional treatment.
ABSTRACT
BACKGROUND: 3,4-Methylenedioxymethamphetamine (MDMA) is one kind of amphetamine-type stimulants (ATS) with stimulating and hallucinogenic properties, and its damage to human is extremely serious and complicated. It has become a research hot in the field of addiction behavior abroad. OBJECTIVE: To observe the effect of long-term neurotoxicity of MDMA on cognitive function. DESIGN: A randomized control animal experiment. SETTING: Laboratory of Psychopharmacology, Mental Health Center, West China Hospital of Sichuan University. MATERIALS: The experiment was carried out in the Laboratory of Psychopharmacology of the Mental Health Center, West China Hospital of Sichuan University from July 2003 to February 2004. Sixteen male adult Wistar rats, provided by the animal center of Sichuan university, were randomly assigned to study group (n=10) and control group (n= 6). INTERVENTIONS: Rats in study group were administrated with MDMA (10 mg/kg), once per hour for four times, and the total amount was 40 mg/kg, and those in the control group were treated with saline of the same volume. The Morris water-maze test was performed at 2, 8, 26 and 32 weeks after the last administration respectively to observe the spatial learning and memory function. MAIN OUTCOME MEASURES: The escape latencies and the times of crossing the exact position of the former platform were observed at 2, 8, 26 and 32 weeks after the last administration respectively. RESULTS: Four rats in the study group died within 12 hours during the experiment, 1 in the study group and 1 in the control group died at 6 and 17 weeks respectively, finally 5 rats in the study group and control group left till 32 weeks respectively. At 2, 8, 26 and 32 weeks after the last administration, there were no .significant differences in the escape latencies between the two group (P ＞ 0.05), and the times of crossing the exact position of the former platform also had no significant differences [(7.67±2.16), (7.50±2.95) times; (6.60±1.14), (7.0±1.67) times;(7.40±1.52), (6.60±2.61) times; (6.80±4.55), (5.80±1.79) times; P ＞ 0.05]. CONCLUSION: The long-term neurotoxicity of MDMA has no obvious effect on the spatial learning and memory function.
ABSTRACT
BACKGROUND: Methamphetamine (MA) has neurotoxic effects to central nervous system. However, as the 5-hydroxytryplamine reuptake enhancer, it is uncertain that if there are protective effects of tianeptine to the damages of 5-hydroxytryp-taminergic neurons caused by MA.OBJECTIVE: To investigate the neurotoxicity of MA and the neuroprotective effects of tianeptine as well as the acting mechanism.DESIGN: Randomized case control study based on animals.SETTING: Animal research room and pathology research room of a university.MATERIALS: The experiment was completed in the Experimental Animal Centre of Sichuan University and Molecular Pathology Laboratory of West China Hospital during June to August 2003. Totally 25 male Wistar rats were injected MA through abdominal cavity to build model. Methamphetamine was provided by National Institute for the Control of Pharmaceutical and Biological Products(NICPBP) while tianeptine was given by French Servier Company (Batch No. OE3086). The TUNEL testing kit was purchased from Boehringer Mannheim Company.INTERVENTIONS: There were one control group and four experimental groups(A, B, C, D). A group was used intraperitoneal injection of MA while B, C, D, groups were administered tianeptine 7 days, 4 days before and the same day of MA administration. Normal saline with same volume was injected into rats of control group. HE stain and silver stain were conducted after experiment to observe the morphologic changes of neurons. And TUNEL method was used to detect apoptotic cells.MAIN OUTCOME MEASURES: The HE stain and silver stain of brain tissue sections and counts of TUNEL positive neurons.RESULTS: MA could damage the axon and dendrite of neurons and the absorbance of silver positive cell was(50.74 ± 1.86) . It could also induce cell apoptosis while the apoptotic cell count every high power field was 29.26 ±4. 14. There were less apoptotic cells in the group with 7 days usage of tianeptine with the cell count of( 18.90 ± 1.60) per high power field.CONCLUSION: MA can cause neurotoxicity by inducing cell apoptosis.And giving tianeptine in advance can protect neurons.
ABSTRACT
Objective To study the features of hippocampal atrophy (HA) by MRI in mild Alzheimer's disease(AD) patients. Methods Fifteen mild AD patients and 30 healthy controls were included in this study and all subjects were examined by both MRI and MMSE. The differences in the hippocampal volume between the mild AD and the control were analysed, and relationships between the hippocampal volume and age, MMSE scores were evaluated. Results The hippocampal volume of the mild AD was decreased significantly than that of the controls 〔(2 08?0 46)cm 3 vs (3 11?0 19)cm 3, t =2 71, P 0 05). Conclusions MRI-based HA could be used to differentiate the mild AD patients effectively from the healthy subjects and could also be regarded as a status marker for the early clinical diagnosis of AD.