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Objective:To evaluate the diagnostic evaluation process and the effectiveness and safety of intracavitary therapy for pelvic congestion syndrome (PCS).Methods:A retrospective analysis was conducted on 38 patients admitted to Beijing Shijitan Hospital affiliated to Capital Medical University from March 2019 to February 2022. Combined with the patient′s symptoms, PCS was diagnosed by color Doppler ultrasound, computed tomography venography (CTV), and venography. The ovarian vein was embolized with controllable spring coil and polydocanol foam sclerosing agent. The patients were followed up 1, 3 and 6 months after operation.Results:The total surgical success rate of 38 patients was 100%, and the incidence of complications was 5.3%(2/38); Spring coils (2.8±0.3)per person; The dosage of hardener was (7.0±2.1)ml/person. The improvement rate of patient symptoms was 97.4%(37/38); After 1, 3, and 6 months of surgery, color Doppler ultrasound was reexamined and no recanalization was observed in the embolized ovarian veins; The diameter of the parauterine vein was (2.8±0.5)mm, which was significantly lower than the preoperative (7.5±1.9)mm ( P<0.05); The Visual Analogue Scale (VAS) score was significantly lower than the preoperative score [(2.12±1.87)points vs (7.58±0.82)points, P<0.001]. Conclusions:Process based assessment is helpful in identifying and diagnosing PCS patients who urgently need treatment; Endovascular treatment based on embolization of ovarian vein with controllable spring coil and foam sclerosing agent is minimally invasive, safe and effective.
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Objective:To evaluate the role of Angiojet thrombus clearance device in the treatment of dialysis access thrombosis.Methods:The clinical data of 37 patients with Angiojet thrombus clearance due to hemodialysis thrombosis from May 2019 to May 2021 were retrospectively analyzed.Results:The clinical success rate was 100%, the mean operation time was (42±21) minutes. The time of aspiration was (35±18) s, and the average length of occlusion was (8±5) cm. All patients were treated with balloon dilation after aspiration. The average postoperative dialysis flow was (270±15) ml/min. The mean length of stay was (2.0±1.5) days. There were no surgically related deaths, no vascular rupture or bleeding, no major complications. Dilated local pseudoaneurysm formation was observed in 5 patients after dilation by angiography without special treatment. The mean follow-up time was 11 months. The primary patency rate was 85% and the secondary patency rate was 87% at 6 months post operatively.Conclusion:Angiojet thrombus removal device has the advantages of minimally invasive, short operation time and repeatability.
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Objective:To observe the clinical effect of TurboHawk plaque excision system combined with drug-coated balloon in the treatment of femoral popliteal artery in-stent restenosis.Methods:The clinical and follow-up data of 13 patients with femoral popliteal artery in-stent restenosis were retrospectively analyzed, ankle-brachial index (ABI) and lower extremity artery CTA before and after surgery were recorded.Results:Surgery was successful in all the 13 patients.There was perioperative death, no major complications. One patient underwent salvage stent implantation due to residual stenosis of more than 30% in the proximal end of the stent after rotary cutting and expansion . The average postoperative ABI was (0.90±0.08), significantly higher than that before the operation ( P<0.05). All patients were followed-up for mean 16.4 months, One patient died of acute heart failure after 13 months, one of the lower extremity vascular CTA confirmed in-stent restenosis was treated by drug-coated balloon. The primary patency rate was 84.6% at one year. Conclusion:The mid-term results of directional atherectomy system combined with drug-coated balloon in the treatment of femoral artery in-stent restenosis is satisfactory.
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Objective:To evaluate the effectiveness of the Caprini risk assessment model in predicting deep venous thrombosis in hos-pitalized patients with malignant tumors. Methods:Deep venous thrombosis screening was performed in 504 patients with malignant tumors who were hospitalized in Beijing Shijitan Hospital between January 2015 and January 2017. Their Caprini thrombosis risk mod-el scores and risk classifications were analyzed and compared with those of the Khorana risk model. Results:The median Caprini score of patients with deep venous thrombosis was 6 (range 4-8), which was higher than the score of 5 (range 4-7) in the group without deep venous thrombosis (Z=10.033, P=0.004). Statistically significant differences in the incidence of deep venous thrombosis were found among the low-medium, high-, and extremely high-risk groups (Z=-1.933, P=0.053). The area under the receiver-operating char-acteristic curve (AUC) of the Caprini scores was 0.611 [95% confidence interval (CI): 0.54-0.69, P=0.004], and the cutoff value was 6 points, with the largest Youden index. The AUC of the Khorana model was 0.65 (95% CI: 0.57-0.72, P<0.001), and the difference be-tween the Khorana and Caprini models was not statistically significant (Z=0.674, P=0.500). The AUC of the Caprini model was 0.85 (95% CI: 0.66-0.96, P<0.01) and that of the Khorana model was 0.68 (95% CI: 0.47-0.84, P=0.18) in the patients who underwent malig-nant tumor surgery. The AUC of the Khorana model was 0.72 (95% CI: 0.61-0.82, P=0.01) and that of the Caprini model was 0.55 (95% CI: 0.44-0.67, P=0.54) in the non-operative patients who received chemotherapy. Conclusions:The Caprini and Khorana risk assess-ment models have certain predictive values, but the discrimination is not good. The Caprini model is providing better predictability in patients with malignant tumors treated with surgery. The Khorana model is suitable for non-operative patients who received chemo-therapy. Further studies on the application of the Caprini risk assessment model in patients with malignant tumors are needed.
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Objective To evaluate the safety and efficacy of preparatory catheter-directed thrombolysis together with assisted endovascular angioplasty in treating chronic occlusive arterial disorders of lower extrenities under the second time window principle for thrombolysis.Methods From Jan 2001 to Dec 2014,preparatory catheter-directed thrombolysis together with assisted endovascular angioplasty was performed in 206 patients with chronic occlusive arterial disorders of lower extremities.All the patients had a history of chronic ischemia of lower limb for an average of (20 ± 9) months (3-60 months).Anklebrachial index (ABI) was 0.00-0.65 with a mean of (0.33 ± 0.22).Results The mean time of thrombolysis was 72 hours (within a range of 24-120 h).The D-dimer level multiplied next day after thrombolysis.The occluded length of the diseased arteries before the treatment was 60-180 mm,with a mean of (90 ± 27) mm.After catheter-directed thrombolysis,the occluded length decreased to 20-60 mm [mean of (40 ± 15) mm].Thrombolysis was effective in 192 patients (92％).Endovascular angioplasty was successfully completed in all patients after thrombolysis therapy.Postoperative ABI was 0.64-1.0 [mean of (0.86 ± 0.11)].During the perioperative period no complications nor death occurred.Conclusions Under the guidance of the second time window principle for thrombolysis,preparatory catheterdirected thrombolysis together with assisted endovascular angioplasty is an effective and safe treatment for chronic occlusive arterial disorders of the lower extremities.
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Objective To compare the effect of nursing students acting as social volunteers to participate in gerontological nursing practice teaching with traditional practice teaching mode, and promote the reform of teaching mode in nursing practice. Methods Students of two classes from department of nursing, medical college of Wuhan University of Science and Technology were selected as research objects. In class one nursing students acted as social volunteers to participate in gerontological nursing practice teaching (the experimental group), In class two nursing students took practice in geriatric wards according to traditional practice mode(the control group). The practice effect was compared between two groups. Results The average final grade of the experimental group was 86.50, and 78.51 in the control group. Ridit analysis revealed that, setting class one as the experimental group, R=0.796 8,95% confidence interval was 0.715 1-0.878 4, in the control group, R =0.500 0. The investigation showed that the experimental group and the control group were different in moral elevation aspect, teaching level, capability improving aspect and employment promotion aspect, the difference was significant (P<0.01). Conclusions The mode of nursing students acting as social volunteers to participate in gerontological nursing practice teaching has advantage over traditional practice teaching, and it can gain satisfying teaching effect.
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Objective] To analyse the academic thought of Professor Li Guixian, the famous veteran doctor of TCM and academic experience instructor of treating ulcerative colitis. [Methods] In-depth analyse the pathogenesis of ulcerative colitis, explore the academic connotation of Professor Li Guixian treatment of ulcerative colitis based on traditional Chinese medicine theory, according to the ancient classics. [Results] Professor Li Guixian puts forward the viewpoint that pathogenesis in the process of evolution of ulcerative colitis has a great relationship with the fundamental of spleen and stomach, symptoms of damp and heat-toxin, the outline of Qi and blood ,not only in line with the characteristics of the occurrence and prognosis of the disease but also has its theoretical basis ,combined with her many years of clinical experience. [Conclusion] The way of “invigorating spleen to help transport and transform the essence of water and grain, regulating the function of qi and blood, removing the muddle of damp and heat-toxin”of treating ulcerative colitis has clinical significance.
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<p><b>OBJECTIVE</b>To identify the risk factors associated with the severity of pulmonary embolism among patients with deep venous thrombosis of lower extremities.</p><p><b>METHODS</b>This prospective study enrolled 208 patients with acute deep venous thrombosis to screen for pulmonary embolism between July 2010 and July 2012 in Beijing Shijitan Hospital. There were 101 male and 107 female patients, with a mean age of (59 ± 16) years. Gender, age, extension, side of lower extremities of deep venous thrombosis was analyzed by χ² test. Ordinal Logistic regression was used to determine risk factors associated with severity of pulmonary embolism.</p><p><b>RESULTS</b>There were 83 patients with iliofemoral deep venous thrombosis, 102 patients with femoropopliteal and 23 patients with calf deep venous thrombosis. Pulmonary embolism was detected in 70 patients with the incidence of 33.7%. Pulmonary embolism was significantly correlated with extension (χ² = 17.286, P = 0.004) and sides (χ² = 15.602, P = 0.008) of deep venous thrombosis, not with age (χ² = 7.099, P = 0.260), gender (χ² = 7.014, P = 0.067), thrombotic risk factors (χ² = 3.335, P = 0.345) in univariate analysis. Results of multivariate ordinal logistic regression showed that iliofemoral vein thrombosis (OR = 6.172, 95% CI: 1.590 to 23.975, P = 0.009) and bilateral venous thrombosis (OR = 7.140, 95% CI: 2.406 to 24.730, P = 0.001) are associated with more serious pulmonary embolism.</p><p><b>CONCLUSIONS</b>Incidence of pulmonary embolism is still high in patients with deep venous thrombosis. Extensive iliofemoral and bilateral vein thrombosis may increase risk of severity of pulmonary embolism. Clinicians should pay more attention to these high-risk patients.</p>
Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Acute Disease , Incidence , Logistic Models , Lower Extremity , Pathology , Prospective Studies , Pulmonary Embolism , Diagnosis , Pathology , Risk Factors , Veins , Pathology , Venous Thrombosis , Diagnosis , PathologyABSTRACT
Objectives To assess outcomes of endovascular treatment for critical limb ischemia in patients with TASC C and D femoropopliteal lesions.Methods Between January 2009 and January 2012,patients with critical limb ischemia for TASC Ⅱ C or D lesions underwent endovascular treatment.Patients demographic,pre-and post- procedure ABI,primary patency rate,limb salvage at 1,3,6,12,24 months were reviewed.Results There were 58 males,38 females, mean age was (76 ± 10 ) years,with Rutherford Ⅳ in 68 limbs,Ⅴ in 23 limbs,Ⅵ in 5 limbs.Successful rate of procedure for target lesions was 94.80％,angioplasty alone was performed in 13 limbs,stent in 80 patients,thromblysis assisted angioplasty and stent in 8 limbs.Stents of popliteal artery were implanted in 47 limbs.Major complication rate was 19.80％,two patients died within 30 days.Mean ABIs were 0.25 ±0.17 and 0.76 ±0.23 before and after procedure.Mean time of follow up was (12 ± 6) months.Primary patency rates and limbs salvage rate were 94.79％ and 95.83％,93.73％ and 95.83％,88.01％ and 93.42％,78.34％ and 93.42％,68.38％ and 83.04％ on 1,3,6,12,24 months respectively.Conclusions Patients with critical limb ischemia caused by TASC C/D lesions often suffer from significant comorbid medical conditions.Endovascular procedure has a high risk of morbidity and restenosis,but short term limb salvage rate is satisfactory.
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Objective To examine outcomes of superficial vein stripping for vein varicosis caused by combination of superficial and deep venous reflux and the effect on deep vein reflux. Methods From January 2004 to December 2006, twenty patients (22 lower extremities) with combined superficial and deep venous reflux were enrolled for evaluation, patients with superficial venous reflux alone worked as controls.All patients underwent superficial vein stripping and followed up for 2 years. Venous clinic severity score (VCSS) and color duplex ultrasound test were used to evaluate the change of clinic symptoms and valve reflux of deep veins. Results Preoperative VCSS of superficial and deep vein reflux group and superficial vein reflux group was 7.1 ± 2. 9 and 6. 6 ± 2. 0 respectively (P = 0. 44). At two years after operation the VCSS was 2. 3 ± 1.2 and 1.8 ± 0. 8 respectively without significant statistic differences, whereas comparing postoperative VCSS with individual preoperative parameters there was a significant decrease (P <0. 01). In combined superficial and deep vein group, deep venous reflux reduced in 7 limbs, progressed in 4 limbs, no change in 12 limbs. While in superficial reflux alone group, deep venous reflux occurred in 4 limbs.Conclusions Superficial vein stripping effectively improves symptoms of great saphenous vein varicosis of lower extremity caused by combination of superficial and deep vein reflux without a significant effect on the stares of deep vein reflux.
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Objective To explore segmantal blood pressure ratio in Doppler ultrasound in the evaluation of distal outlets in lower extremity atherosclerosis ocllusion patients undergoing blood vessel prosthesis and provide references to surgical indications. Methods A review research was made on 166 lower extremity atherosclerosis ocllusion patients receiving blood vessel prosthesis therapy in Anzhen hospital in 1998--2005. We analyzed related factors including segmantal blood pressure ratio to potency rate, evaluated the difference of segmantal blood pressure ratio between groups in which the blood vessel prosthesis was patent and that it was not. Results The difference of segmantal blood pressure ratio of outlet is one of the highest risk among risk factors. The Mean ± SDs of segmantal blood pressure ratio of outlet in patent and obstructed groups were 0. 12±0. 09 and 0. 24±0. 14 respectively. The difference of segmantal blood pressure ratio of outlet has a significant difference between the two groups ( P = 0. 001 ). The corresponding 95% confidence interval of patent group is (0,0. 27). Conclusion Doppler ultrasound is a quantitative testing method. The confidence interval of the difference of segmantal blood pressure ratio could be used as the primary reference standard for the assessment of the outlet and to expect the potency rate before the vascular surgical procedures.
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Objective To sum up the experience in the diagnosis and management of acute lower extremity arterial injury.Methods Between Jan 1988 and Feb 2004,125 cases of lower limb arterial injuries were admitted and undergoing surgery, including gunshot in 3 cases, blunt trauma in 56 and stabbing in 66 cases. Associated injuries included bony injury in 36 cases, nerve injury in 11 cases, and vein injury in 23 cases. Arterial primary or patch repair was performed in 28 cases, end-to-end anastomosis in 37 cases, saphenous vein graft used in 32 cases, prosthetic graft bypass in 23 cases, thrombectomy in 2 cases and blood vessel ligation in 3 cases.Results Limb salvage rate was 85.6% and patient survival of 98.4%. Massive bleeding and multiple organ failure caused mortality in one each. The rate of amputation is 10.4%(13/125), with preoperative gangrene being present in 8 cases.Conclusion Lower extremity arterial injury carries a high amputation rate. The use of Doppler scanner is helpful for early diagnosis. An ankle/brachial index of less than 1 in the affected limb was considered as a positive sign of arterial injury. Prompt revascularization and early fasciectomy are important to reduce amputation rate and mortality.
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Objective To observe the effect of heat shock protein 70 (HSP70) expression induced by Herba Hedyotis Diffusae (HHD) on the apoptosis of H22 hepatoma cells.Methlds Mice were immunized with H22 hepatoma cells from in-vivo ascites of the mice pretreated by HHD and Radix Codonopsis (RC).Mice were divided into five groups after being blocked with HSP70 monoclonal antibody:non-HHD blocking group,HHD blocking group,non-RC blocking group,RC blocking group and the blank control group,10 mice in each groups.Then the mice were attacked with cultured H22 hepatoma cells to induce transplanted tumor.The apoptosis in the transplanted tumor was detected by a terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling(TUNEL) method.Results Large amount of brown particles can be observed in the cell nucleus of transplanted tumor mice from HHD groups.Compared with RC groups,number of apoptotic cells and the staining intensity were increased in HHD groups.The apoptosis in HHD groups and RC groups differed from that in the blank control group,and was obvious in HHD groups.The apoptosis exerted a increasing tend in non-HHD blocking group,but the difference was insignificant between non-HHD blocking group and HHD blocking group,and between non-RC blocking group and RC blocking group.Conclusion HHD can promote the apoptosis of H22 hepatoma cells in transplated tumor through inducing the expression of HSP70 to some extent,and the related mechanism of inducing apoptosis needs further research.
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ObjectivesTo analyse the causes of occlusion of prosthetic grafts and to explore the appropriate modality of reoperation.MethodThe clinical data of 47 patients with occlusive prosthetic grafts were analyzed retrospectively. The procedure of treatment for patients with different causes of occlusive graft included thrombectomy alone in 9 cases, thrombectomy and anastomotic plasty in 16 cases, new bypass using prosthetic graft and saphenous autograft in 22 cases. ResultsThe reoccurrence of graft occlusion in patients undergoing thrombectomy alone or thrombectomy and anastomotic plasty was 67% and 56% respectively, which was siginificantly higher than that of 9% in patients treated by a new arterial bypass with prosthetic grafts and saphenous autografts. ConclusionsThe result of new bypass for occlusive prosthetic graft is superior to thrombectomy alone or thrombectomy and anatomotic plasty.
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Objective To observe the effect of Herba Hedyotis Diffusae(HHD) on expression of heat shock protein 70(HSP70) and P16 anti-oncogene protein in mice with H22 cell transplanted tumor. Methods The mice were immunized with hepatoma-lines-H22 cells which were treated by Chinese herbs firstly. According to the pretreatment of the Chinese herbs and whether the H22 cells being blocked by HSP70 monoclonal antibody,the mice were divided into 5 groups:HHD non-blocking group,HHD-blocking group,Radix Codonopsis(RC)-blocking group,RC non-blocking group,and RPMI-1640 control group. Then the treated H22 Cells were translated into the mice. The expression of HSP70 and P16 anti-oncogene protein in mice with transplanted H22 liver carcinoma was detected by immunohistochemical marking method. Results The expressions of HSP70 was up-regulated in HDD non-blocking group and RC non-blocking group,in particular in RC non-blocking group,and the difference was significant as compared with HHD-blocking group,RC-blocking group and control blank group.The expression of P16 anti-oncogene protein was up-regulated in the treatment groups,and the difference was significant in comparison with the control group. The effect on P16 anti-oncogene protein expression was stronger in HDD groups than that in RC groups,but the difference was insignificant between the blocking group and the non-blocking group of each herb. Conclusion The anti-tumor effect of HDD may be achieved by inducing HSP70 expression in transplanted H22 neoplasia and by enhancing the immunogenicity. The up-regulation of P16 anti-oncogene expression by HHD and RC has no direct relationship with the induction of HSP70,and the related mechanism needs further research.
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Objective To summarize our surgical experience on 187 patients undergoing open repair of abdominal aortic aneurysms (AAAs). Methods Data of 187 patients with infrarenal AAA who were treated electively with open repair between January 1992 and February, 2004 were retrospectively reviewed. Results One patient (0.54%) died perioperatively due to ventricular premature beat, ventricular fibrillation 6 hours after. The mean duration of operative procedure was 3.8 hours. The mean blood loss was 445 ml. Perioperative complications included heart failure in 17 cases, respiratory failure in 8, acute myocardial infarction in 2, cerebral infarction in 1, and acute renal failure in 3. The 1? 3? 5-year survival rate was 97.0%? 84.6% and 78.3%, respectively. Conclusion The aneurysm diameter is not the absolute operative indication. Risk factors for open operation of AAA are old age, severe cardial, pulmonary diseases and renal desfunction. Open surgery is still the treatment of choice for AAA.