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Objective@#To investigate the clinical outcomes of skin and soft tissue expansion in the repairment of neck scar.@*Methods@#From March 2009 to May 2018, 15 patients with postburn scar contractures on neck, were admitted to the Department of Burn and Plastic Surgery, Karamay Central Hospital of Xinjiang. The patients include 12 males and 3 females, aged 12 to 48 years, with the mean age of 31 years. The scars were at 9 cm×6 cm-14 cm×11 cm in size. The tissue expander of 100-300 ml was placed subcutaneously, in the normal skin area on neck, on one or each side at the first stage operation. The first expander infusion was performed 10-14 days after surgery. The tissue expansion remains for 3-9 months, with an interval of 10 days of each infusion. After the tissue fully expanded, the expander was maintained for 1 month. At the second stage, the expander was removed, and the expanded flap was transferred to repair the wound.@*Results@#The expander exposure due to friction occurred in 2 patients. The final therapeutic effect was not affected, because of iodine gauze bandage. Blood supply of expanded flaps was good in other patients. The size of the expanded flaps was 12 cm×8 cm-16 cm×15 cm. All flaps survived after the second stage surgery. Patients were followed up for 0.5-5 years after surgery. The color and texture of flaps was similar to adjacent normal skin.@*Conclusions@#Skin and soft tissue expansion is a safe and effective method in repairing neck scar.
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Objective To investigate the clinical short-term efficacy and safety of transarterial chemoembolization (TACE) by using CalliSpheres drug-eluting beads combined with blank microspheres (8 Spheres) in treating advanced hepatocellular carcinoma (HCC) . Methods The clinical data of 98 HCC patients, who were treated at authors′ hospital during the period from July 2016 to November 2017, were retrospectively analyzed. The patients were divided into DEB-TACE group (receiving TACE by using CalliSpheres drug-eluting beads combined with 8 Spheres embolic microspheres, n =50) and cTACE group (receiving TACE by using opium poppy ethyl iodized oil together with 8 Spheres embolic microspheres, n =48) . The disease remission rate, control rate and incidence of complications as well as preoperative and 3-day postoperative hepatic function indexes were collected, and the results were compared between the two groups. Results No statistically significant differences in baseline data existed between the two groups (P>0.05) . Both the 3-month and the 6-month disease remission rates in DEB-TACE group were remarkably higher than those in cTACE group (P<0.05), besides, the 6-month disease progression rate and the incidence of elevated serum AFP in DEB-TACE group were lower than those in cTACE group, the short-term efficacy of DEB-TACE group was better than that of cTACE group (P<0.05) . Three days after treatment, the levels of ALT and AST in cTACE group were strikingly higher than those in DEB-TACE group (P<0.05) . No serious adverse reactions occurred in both groups. Conclusion In treating advanced HCC with TACE, the short-term efficacy and safety of CalliSpheres drug-eluting beads combined with 8 Spheres embolic microspheres are superior to those of opium poppy ethyl iodized oil together with 8 Spheres embolic microspheres.
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Objective To evaluate clinical value of ultrasound contrast agent the sulfur hexafluoride micro-bubble in the treatment of T2WI high signal uterine fibroids with high intensity focused ultrasound (HIFU).Methods A total of 36 patients with T2WI high signal uterine fibroids were randomly divided into experimental group and control group.Eighteen patients in experimental group received HIFU treatment with sulfur hexafluoride micro-bubble before,during and after the operation while another eighteen in control group received HIFU treatment with sulfur hexafluoride micro-bubble only after the operation.We recorded operation time (min),changing time of massive gray (s),irradiation time (s),therapeutic dose (J),incidence of complications and ablation rate (％).Results Operation time,changing time of massive gray,irradiation time,and therapeutic dose in experimental group were (101.51±43.02) min,(856.42±451.14) s,(1077.37±546.23) s,and (496581.81 ± 267192.31) J,respectively while those in control group were (261.34 ± 85.53) min,(1 833.32 ± 642.67) s,(1 890.21 ± 1 268.43) s,and (784 608.31 ± 357 621.45) J,respectively.Significant differences were found among those parameters between the two groups (P ＜0.05).Tumor ablation rate in experimental group was 83.3％ while that in control group was 55.5％,which was of significant difference between the two groups (P＜0.05).One case of muscular stiffness was found in experimental group while one case of second-degree burn and two cases of muscular stiffness were found in the control group.The incidence of complications was 1/18 (5.5％).No severe complication like bowel perforation or bladder perforation was found in the two groups.Conclusion The effect of ultrasound contrast agent sulfur hexafluoride micro-bubble can shorten operation time,improve tumor ablation rate and reduce complications and it can play a guiding role in clinical work.
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Objective To investigate the clinical application of temporary balloon occlusion of the common iliac artery in performing cesarean section for patients with pernicious placenta previa and placenta accreta.Methods A total of five cases with ultrasound or MRI diagnosed pernicious placenta previa and placenta accreta were analyzed retrospectively.One of the cases was diagnosed Rh(-)blood type.Prophylactic temporary balloon implantation in bilateral common iliac arteries were carried out before cesarean section.Digital subtraction angiography ensured the position of balloon catheter and the catheter was fixed.The balloon was inflated immediately after the removal of the fetus.The balloon was removed at 6-8 hours after the cesarean section.The amount of blood loss,transfusion requirement,cesarean hysterectomy rate, and X-ray exposured time and dose during the procedure were recorded.Results Temporary balloon implantation in bilateral common iliac arteries in all five patients were obtained successfully.The blood loss was seen <500 mL in one patient and 500-1 000 mL in other four patients.Because of placenta implantation over depth of serosa and placenta percreta in one case,massive intractable hemorrhage occurred in short time,partial hysterectomy had to be carried out.The uterus was retained in other four cases.Conclusion The temporary balloon occlusion of the common iliac artery in performing cesarean section is a safe and effective technique,and it can reduce the amount of blood loss,transfusion requirement and secondary risk due to uncontrollable bleeding during surgery.
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Objective To evaluate the clinical application and therapeutic effect of interventional embolization in treating renal pseudoaneurysms. Methods The clinical data of 11 patients with renal pseudoaneurysm, who had received interventional embolization management at authors’ hospital, were retrospectively analyzed. The embolic agents used in the embolization procedure included conventional steel coil, gelatin sponge particles, PVA, etc. All the patients were followed up for 6-24 months. Results Single renal pseudoaneurysm was found in all the 11 patients. Clinically, symptom of bleeding was seen in 3 cases. The renal pseudoaneurysm was located at the upper (n=1), middle (n=4) and lower (n=5) renal artery of the kidney, and in one case the renal pseudoaneurysm was situated at the accessory renal artery. In performing renal artery embolization, pure PVA was used in one case, spring steel coil in one case, PVA together with spring steel coil in one case, and gelatin sponge combined with spring coil in 8 cases. After the embolization, the pseudoaneurysm was no more visualized, the contrast extravasation disappeared, and the parent artery was manifested as a residual root. During the operation the patients had no obvious discomfort. Within one week after embolization therapy, 2 patients developed hemorrhage, and their hemoglobin, white blood cell count and hematocrit were significantly increased. During the follow-up period, all patients showed no recurrence signs, and routine urine tests were normal. Conclusion For the treatment of renal pseudoaneurysms, interventional embolization is minimally-invasive, safe and reliable; this technique can maximally protect the normal kidney tissue, quickly control the bleeding and effectively save the life of patient. Therefore, it is worth promoting this treatment in clinical practice.
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Objective To evaluate DSA and MRI in diagnosing focal nodular hyperplasia(FNH) of the liver.Methods DSA and MRI findings in seven patients with pathologically-proved FNH were retrospectively analyzed.Selective hepatic arteriography with DSA,and both plain and dynamic contrastenhanced MR scans were performed in all patients.The imaging findings were retrospectively evaluated and analyzed.Results On DSA examination,all FNH lesions were hyper-vascular,which were characterized by thickened and tortuous feeding arteries.And the feeding arteries,after entering the lesions,branched off peripherally in a radiation pattern and the lesions were evenly dyed with sharp borders.In venous phase,hepatic vein drainage was demonstrated in 6 cases.On dynamic contrast-enhanced MRI,marked enhancement of the lesions was observed,which lasted until to delayed phase when the lesions still showed hyper-intensity or iso-intensity signals.Scar signal in the lesion's center was seen in three cases,which started to enhance at portal vein phase and maintained to delayed phase.Conclusion On DSA imaging,FNH lesions are characterized by thickened and tortuous feeding arteries that branch off peripherally in a radiation pattern after entering the lesions.And the hepatic vein drainage is also a common finding in venous phase.Dynamic contrast-enhanced MRI can well display the abnormal signal of the central scar of FNH.The combination use of DSA and MRI can effectively improve the diagnostic accuracy for FNH.
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Objective To study the ultrastructural changes of hypertrophic scars and animal wound healing models induced by radionuclide 90 Sr exposure and to get the most effective dosage and time in the prevention and treatment of scars. Methods The clinical hypertrophic scars and animal wound models were exposed using 90 Sr applicator in this study. The exposure doses were 200 800 cGy and 200 4 000 cGy. Then the fibroblastic ultrastructure of the tissues from the experimental and control groups were observed with transmission electron microscope. Results Compared with the control groups, capillaries and fibroblasts obviously increased in small and medium doses (200 600 cGy) groups and fibroblastic function was activated. The fibroblasts decreased and fibroblastic function was inhibited in large dose (800 2 000 cGy) groups. Conclusions Small and medium dose of 90 Sr can accelerate wound healing, and can therefore be used in the treatment of early wounds (2 3 days after wounded) ; large dose of 90 Sr can prevent scars from hyperplasia, and can be used in the wounds of the first week after operation; 1 000 2 000 cGy 90 Sr can cure the old hypertrophic scars or keloids; It is useless that 90 Sr exposes before operation for prevention of scars.The most effective method to prevent scars from hyperplasia is large dose of 90 Sr exposure after operation.