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Objective To evaluate the technical feasibility and safety of a single-incision technique via axillary vein (AV) for placement of totally implantable venous access port (TIVAP) guided by ultrasound combined with DSA in clinical application. Methods We retrospectively analyzed clinical data of 240 patients who received TIVAP by single incision technique via AV access guided by ultrasound combined with DSA. We observed and recorded operation-related information such as AV width, AV puncture success rate, implantation success rate, ultrasound-guided puncture time, operation time and intraoperative and postoperative complications, etc. Results All 240 patients were successfully implanted with TIVAP, and the success rate was 100%. In 229 cases, TIVAP was implanted through single-incision AV puncture under the guidance of ultrasound combined with DSA, and the success rate of AV puncture was 95.42% (229/240). In 11 cases, TIVAP was implanted through the ipsilateral internal jugular vein (IJV) under the guidance of ultrasound combined with DSA due to the failure of AV puncture. In the 240 patients, the average width of AV of the intended puncture segment was (7.56±1.26) mm measured by preoperative ultrasound exploration and positioning, in which 195 cases were successfully punctured once, 26 cases were successfully punctured twice, and 8 cases were successfully punctured three times, with the success rate of 81.25%, 10.83% and 3.34%, respectively. The average puncture time under ultrasound guidance was (0.85±0.52) min, and the average operation time was (25.9±4.8) min. The incidence of intraoperative complications was 1.67% (4/240). No hemothorax, hemopneumothorax or serious fatal complications occurred. The incidence of complications during TIVAP retention was 2.92% (7/240). No complication such as catheter-related bloodstream infection, catheter-related venous thrombosis, catheter rupture/displacement, clipping syndrome or drug extravasation was observed. Conclusion Ultrasound combined with DSA guided single-incision technique via AV access in the implantation of TIVAP is a feasible and safe implantation method with high technical success rate, short operation time and low risk of complications. It can be used as another choice of TIVAP implantation method.
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Through the treatment of difficult case in a gynecology and obstetrics and doctor-patient communication,this paper analyzed how obstetricians and gynecologists should start from themselves,properly treat the patients,reduce the disputes and conflicts and harmonize the relationship between doctors and patients.It is believed that doctors should get patients' trust through improving their own medical technology,enhance communication skills,use "Platinum Law" to understand patients'needs,respect patients' right of informed consent,adopt reasonable requests and suggestions of patients,thus to reach a harmonious consensus of both doctors and patients and seek the best way of treating disease.
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ABSTRACT:Objective To study the effects of arotinolol,propranolol and carvedilol on rat portal hypertension and make a comprehensive evaluation of the three drugs.Methods Portal hypertension was induced with CCl4 in rats.Arotinolol,propranolol,and carvedilol were administered for 2 weeks after the model was stable.Mean arterial pressure (MAP),heart rate (HR)and portal venous pressure (PVP)were measured at intubation;α-SMA expression was measured by immunohistochemistry;Masson staining was used to test collagen fibers area.Results Compared with model group,both arotinolol and carvedilol could significantly reduce PVP level (P significantly declined compared with those in model group (P <0.05 ).Conclusion Arotinolol can significantly reduce cirrhotic rats’ portal pressure,with effects similar to those of carvedilol.The effect of arotinolol in improving liver function is weaker than that of carvedilol,but the side effects on MAP are milder than those of carvedilol.
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Objective To investigate the effects of esophagogastric intramural anastomosis on preventing reflux esophagitis by restoring the cardiac function after esophagectomy.Methods The clinical data of 66 esophagem or cardiac cancer patients(test group)who received esophagogastrie intramural anastomosis at Second Affiliated Hospital of Xi'an Jiaotong University from January 2002 to October 2008 were retrospectively analyzed.Sixty-five patients who received stapled anastomosis during the same period were in control group.Postoperative conditions of patients in the 2 groups were compared by chi-square test and t test.Results (1)Reflux condition:there were 3 patients with degree I and 63 without reflux in test group,and 23 with degree Ⅰ,19 with degree Ⅱ,7 with degree Ⅲ and 16 without reflux in control group.There was a significant difference between the 2 groups(X~2=137.3,P<0.05);(2)results of barium meal fluoroscopy:12 patients in test group and 41 patients in control group had barium reflux,with significant difference between the 2 groups(X~2=27.4,P<0.05);(3)results of gastroscopy:9 patients in test group and 46 patients in control group had morphological changes of mucosa,with significant difference between the 2 groups(X~2=43.5,P<0.05);(4)esophageal sphincter pressure:the pressure of lower esophageal sphincter was(3.4±0.8)kPa in test group and(2.5±0.6)kPa in control group,and the pressure of upper esophageal sphincter wag(7.4±1.7)kPa in test group and(4.2±0.8)kPa in control group.There was a significant difference in esophageal sphincter pressure between the 2 groups(t=4.98,11.59,P<0.05).Conclusion Esophagogastric intramural anastomosis can partly restore the cardiac function and prevent reflux esophagitis effectively.
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Objective To examine the changes of ultrastructural microcirculation of small intestines of portal hypertension (PHT) canines. Methods PHT canine models were established by coarcating a half main portal vein with silk line chronic emboliztion. The ultrastructural changes of small intestine epithelium, mucous membrane and submucosa microcirculation were examined. Results The characteristics of ultrastructural changes of small intestine epithelium, mucous membrane and submucosa microcirculation were as follows: the number of blood vessels was increased and the diameter of them was expanded significantly; the lumen of arteriole was decreased, and the wall was thickened; arteriole collagen fibers were hyperplastic and confused; the lumen of venule was increased, the wall was thinned; basement membrane was damaged; microcirculatary endothelial cell was damaged generally; leukocytes was infiltrated; epithelial cells and basement membrane of intestinal mucosa were damaged; smooth muscle cell nucleus of ileum were deformed. Conclusion Small intestine epithelium, mucous membrane and submucosa microcirculatary ultrastructral showed obvious changes in PHT canines.