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Objective To preliminarily investigate the safety and feasibility of intra-arterial cold saline infusion combined with intravascular reperfusion for acute ischemic stroke with large artery occlusion. Methods From March 2016 to March 2018, consecutive acute ischemic stroke patients with large artery occlusion within 8 h after onset admitted to the Department of Neurology, the People's Hospital of Longhua District, Shenzhen and recanalized successfully after endovascular treatment were enrolled. After recanalization, cold saline was infused through the guiding catheter via the ipsilateral guilty vessel (10 ℃, 33 ml/min for 30 min). Results A total of 20 patients were enrolled, including 15 males. Their median age was 67 years (interquartile range, 53-80 years). Fifteen patients were treated with thrombolysis. A median onset-to-needle time was 300 min (interquartile range, 260-360 min). During the infusion of cold saline, the lowest rectal temperature was only decreased 0. 1 ℃, but within 5 min after completion of perfusion, it returned to the temperature before perfusion. Complications associated with intra-arterial hypothermia were not observed. The median National Institutes of Health Stroke Scale score was significantly decreased from 21 (interquartile range 15-55) before needle to 15 (interquartile range 10-16; Z = -4. 549, P < 0. 001) at discharge. Conclusion Selective intra-arterial cold saline infusion combined with intravascular reperfusion for acute ischemic stroke with large artery occlusion is safe and feasible.
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Therapeutic hypothermia has been shown to improve neurological outcomes after global ischaemia/hypoxia in patients who have had cardiac arrest. Therapeutic hypothermia is one of the most extensively studied and influential therapeutic strategies of acute ischemic stroke. Previous studies of therapeutic hypothermia mainly focused on whole-body cooling. However, delayed induction and systemic complications have limited the clinical application of whole-body cooling. As a selective cerebral hypothermia, the selective intra-arterial brain hypothermia treatment has the characteristics of rapid and even induction of hypothermia, and less affecting the core body temperature. Therefore, it has become a promising treatment modality. This article reviews the application of selective intra-arterial brain hypothermia in acute ischemic stroke and its advantages and limitations in order to provide reference for further experimental studies and future clinical trials.
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Objective To observe the effect of bronchial artery infusion chemotherapy in the treatment of central non-small cell lung cancer (central NSCLC)with obstructive pneumonia and its efficacy clinical factors.Methods Retrospective analysis method was applied to the 64 cases of central NSCLC with obstructive pneumonia.All patients were confirmed by pathology.We main contrasted the efficacy between intravenous infusion of antimicrobial agents and bronchial artery infusion chemotherapy (BAI).we focused on the efficacy between treatment group using standard systemic vein chemotherapy/radiotherapy and primary group with no chemotherapy/radiotherapy.Results In control group,the improvement rate was 43.33%.The improvement rate in treatment group was 70.59%.In treatment group,the curing rate was 50.00% for the patients who had ever taken standard sys-temic chemotherapy/radiotherapy.But the curing rate was 88.89% for the primary group.Conclusion For the patients who have the central NSCLC with obstructive pneumonia,intravenous infusion of antimicrobial agents and bronchial artery infusion chemo-therapy (BAI)can obviously increase the curing rate of obstructive pneumonia.
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Objective To investigate the clinical application value of methotrexate and the particle of gelatin sponge treat ec -topic Pregnancy .Methods A total of 48 cases of ectopic pregnancy was analyzed retrospectively .Methotrexate and gelatin sponge particles were injected into the uterine artery embolization for the method of intervention , and its clinical application value was evalua-ted.Results All 48 patients were embolized uterine artery successfully .It treated successfully ectopic pregnancy 44 cases (92%), including 38 cases of tubal pregnancy and other parts of the 6 cases.All patients were detected in β-human chorionic gonadotropin (β-HCG) until normal about 3 weeks.No serious postoperative complications were found , only 30 patients with abdominal pain, 16 cases of patients with nausea and vomiting , 9 patients with low-grade fever were found .After four months , 29 patients were recanalizated successfully .Conclusions Treatment of ectopic pregnancy can kill embryos efficiently , stanch the bleeding rapidly , and have small operation wound .It is safe and reliable method and is worth populating .
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BACKGROUND/AIMS: Limited options remain for patients with metastatic colorectal cancer (CRC) after failure of standard systemic chemotherapy. Readministration of chemotherapeutic agents by hepatic arterial infusion (HAI) has the rationale of providing higher concentrations of chemotherapeutic agents to hepatic metastases. The present study was conducted to evaluate the efficacy and safety of HAI of fluorouracil with leucovorin (HAI 5-FU/LV) for patients with liver metastases from CRC. METHODS: Fourteen patients with liver metastases from CRC who received HAI 5-FU/LV after failure of systemic chemotherapy containing fluorouracil and leucovorin were identified and their medical records were reviewed. RESULTS: Of 10 patients evaluable for response, one partial response, six stable disease, and three progressive disease were reported. Additionally, the overall response and disease control rates were 7% and 50%, respectively. The median time to progression was 4.3 months (range, 2.9 to 5.6), to hepatic progression was 5.8 months (range, 4.7 to 6.9), and to extrahepatic progression was 5.8 months (range, 2.3 to 9.2). No grade 3/4 hematologic toxicities occurred and one case of abdominal pain and two cases of oral mucositis were the only grade 3 nonhematologic toxicities. Catheter-related complications occurred in three patients: one thrombosis, one infection, and one displacement. CONCLUSIONS: HAI 5-FU/LV was well tolerated and showed modest efficacy for patients with liver metastases from refractory CRC. Readministration of previously used chemotherapeutic agents via the hepatic artery could be an effective salvage option and warrants further investigation in a prospective trial.
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Adult , Aged , Female , Humans , Male , Middle Aged , Antineoplastic Combined Chemotherapy Protocols/administration & dosage , Colorectal Neoplasms/pathology , Fluorouracil/administration & dosage , Infusions, Intra-Arterial , Leucovorin/administration & dosage , Liver Neoplasms/drug therapy , Salvage TherapyABSTRACT
Objective: To evaluate the efficacy and safety of intra-arterial thrombolysis and intravenous thrombolysis in the treatment of acute ischemic cerebral infarction through a meta-analysis. Methods: The literatures of the randomized controlled trials of using urokinase or recombinant tissue plasminogen activator for intra-arterial thrombolysis and intravenous thrombolysis in the treatment of acute ischemic cerebral infarction from January 1 ,2000 to August 5,2010 were reviewed. The primary outcome measures were the proportions of neurological improvement (basic cure + excellent results) in the intra-arterial thrombolysis and intravenous thrombolysis groups. The secondary outcome measures were the European Stroke Scale (ESS) scores after the treatment and the proportion of symptomatic intracranial hemorrhage. The meta-analysis software, RevMan 4. 2 was applied for pooling the data of all the findings. Two reviewers extracted the data independently. Results: A total of 11 articles either from foreign or domestic sources and 723 patients with acute cerebral infarction were included, in which 305 patients underwent intra-arterial thrombolysis and 418 underwent intravenous thrombolysis. Circled digit oneThe total improvement rate of the intra-arterial thrombolysis was 70. 92% and that of intravenous thrombolysis was 61. 29%. There was significant difference between them (χ2 =4. 895,P 0. 7 ). There was no significant difference in thrombolytic modes in the risk of complicating intracranial hemorrhage between the two groups (OR = 1. 12, 95% CI:0. 63 - 2.01,P = 0.69). Conclusion: The efficacy of intra-arterial thrombolysis for acute cerebral infarction is superior to that of intravenous thrombolysis, and both the incidences of symptomatic intracranial hemorrhage is comparable. A large, high-quality randomized controlled trial is need for further verification.
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Objective To investigate the cerebral protective effect of intracarotid infusion of propofol in patients undergoing resection of cerebral gliomas. Methods Sixty ASA Ⅰ- Ⅲ patients with cerebral glioma aged 40-64 yr weighing 48-73 kg were enrolled in this study. Forty patients undergoing resection of glioma under general anesthesia were randomly divided into 2 groups ( n = 20 each): intracarotid propofol group (group IA ) and intravenous propofol group (group Ⅳ). Twenty patients undergoing biopsy of glioma under local infiltration anesthesia with 2% lidocaine 15-20 md served as control group (group C). In IA and Ⅳ groups anesthesia was induced with TCI of propofol and remifentanil. Tracheal intubation was facilitated with rocuronium 0.6 mg/kg. The patients were mechanically ventilated. PErCO2 was maintained at 35-45 mm Hg. Anesthesia was maintained with TCI of propofol and remifentanil and intermittent iv boluses of rocuronium. In group IA internal carotid artery was cannulated after induction of anesthesia and propofol was administered by TCI via carotid artery while remifentanil was administered by TCI via peripheral vein. BIS was maintained at 40-60 during operation. ECG, MAP, HR, SpO2, PETCO2 and BIS were continuously monitored. MAP and HR were recorded before induction of anesthesia (T1) ,during skin incision (T2 ), at the end of operation (T3), during extubation ( T4 ). The glioma specimens were obtained for microscopic examination and determination of aquaporin 1 and aquaporin 4 ( AQP1, AQP4) expression by immunohistochemistry. Results MAP and HR were significantly decreased at T2 and T3 as compared with the baseline at T1 in group Ⅳ ( P ＜ 0.05), while there was no significant change in MAP and HR after induction of anesthesia in group IA ( P ＞ 0.05). The expression of AQP1 and AQP4 was down-regulated in IA and Ⅳ groups compared with group C (P ＜0.05). The propofol consumption during anesthesia was significantly less in group IA than in group Ⅳ (P ＜0.05). There was no significant diffe-rence in AQP1 and AQP4 expression, the amount of remifentanil and recuronium consumed and duration of operation betweenIA and Ⅳ groups ( P ＞ 0.05). Concltsion Intracarotid propofol can decrease the amount of propofol needed for maintenance of anesthesia as compared with intravenous administration and attenuate brain edema,indicating cerebral protective effect.
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Objective This study was to evaluate the protective effect of pulmonary perfusion with cold modified low- potassium dextran (LPD) solution on lung function after cardiopulmonary bypass in combined aortic and mitral valve replacement. Method Twenty-four consecutive adult patients with combined aortic and mitral valve disease were divided into a control group ( n =14) and a perfused group ( n = 10). Cold modified LPD solution was infused to the main pulmonary artery in the protective group. PaO_2/FiO_2 were monitored at six different time points; preoperation, 0 hour, 1 hours, 2 hours, 6 hours and 12 hours after the termination of CPB. Concentrations of interleukin-6 and interleukin-10 in plasma were measured at four different time points; preoperation, 0 hour, 6 hours, and 12 hours after the termination of CPB. Result PaO_2/FiO_2 in the perfused group were increased more than that in the control group. The IL-6 and IL-10 increased in both groups after operations( P <0. 05). Patients of the perfused group showed significantly reduced IL-6 expression, compared with the control group ( P <0. 001), but the rising extents of IL-10 in the perfused group were higher than that in the control group ( P <0.001). Conclusion Pulmonary artery perfusion with cold modified LPD solution during cardiopulmonary bypass relieved lung injury in combined aortic and mitral valve replacement.
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Objective To compare the effect between intra-arterial and intra-venous neoadjuvant chemotherapy(NACT)in stage Ⅰb2-Ⅱ b cervical carcinoma.Methods A retrospective analysis Was done on 52 cases of intra-venous NACT and 95 eases of intm-arterial NACT for stage Ⅰ b2-Ⅱ b cervical carcinoma treatad in Peking Union Medical College Hospital from 1999.ResulIs The response rate of intraveHous NACT and intra-arterial NACT was 88%(46/52)and 79%(75/95).and the operative rate after NACT Was 81%(42/52)and 72%(68/95)respectively(P>0.05).There were no significant differences in surgery time,blood loss and pest-operative morbidity between these two groups.Pathological parametrial positive rate after NACT in arterial group(6%)Was significantly lower than that of venous group (50%,P>0.05).The venous group had very similar recurrence rates(13%vs 17%)and death rates (9%VS 12%)when compared with the arterial group(P>0.05).Conclusions The intra-arterial and intra-venous NACT for stage Ⅰ b2-Ⅱb cervical carcinoma show similar response rate.operative rate and surgical difficulties.Arterial NACT shows a better effect on parametrial infiltration.
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Objective To discuss the safety,efficacy and time window of thombolysis using recombinant staphylokinase(r-Sak).Methods The model of acute cerebral infarction was established with interventional embolization technique in 24 adult beagle dogs,which were randomly divided into 3 groups including control group,6 h intra-arterial group and 3 h intravenous group.Angiography was performed before thrombolysis.We administered r-Sak for thrombolysis(10 ml of saline in control group,0.2 mg/kg of r-Sak in the intra-arterial group through left internal carotid artery 6 h after embolization,and 0.2 mg/kg of r-Sak in the intravenous group through femoral vein 3 h after embolization).Follow-up angiography was repeated half,1 and 2 hours after thrombolysis.The plasma levels of PT,APTT and D-dimer were assayed at the time points of 30 min before thrombolysis,30 min,60 min and 120 min after thrombolysis.These canines were sacrificed,and their brains were taken out for pathological study at 24 hours after embolization.Results The recanaled vessels at 2 hours after thrombolysis was 11(11/13) in the intra-arterial group,8(8/11) in r-Sak intravenous group and 1(1/10) in control group,and the vessels of complete recanalization was 6(6/13),2(2/11) and 0(0/10),respectively.There were statistically significant differences among the three groups (P=0.001 and P=0.035 respectively),but there were no statistically significant differences between the intra-arterial and the intravenous groups (P=0.630 and P=0.211).The PT and APTT are significantly prolonged in the thrombolytic groups.The levels of D-dimer was not changed after thrombolysis (P＞0.05). All dogs were alive 24 h ours after embolization.The clinical presentations in the thrombolytic groups were better.Pathologically,there were no cerebral hemorrhage in all groups.Conclusion r-Sak has strong effect of thrombolysis,and its complication of intracerebral hemorrhage is rare.The intra-arterial thrombolysis 6 h after embolization using r-Sak is safe and effective.
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Objective To evaluate the effect of preoperative chemotherapy on bulky cervical cancer by internal iliac arterial infusion. Methods One hundred and eighty-six patients with bulky cervical cancer were randomly divided into two groups: chemotherapy + radiotherapy group (C+R group, n=105) and radiotherapy group (R group, n=81). Patients in C + R group underwent internal iliac arterial infusion chemotherapy by using Seldinger technique internal iliac arterial or epigastric arterial catheterization. Combined regimens were prescribed including cisplatin as the major drug. Meanwhile ~192 Ir high-dose-rate intracavitary radiotherapy was performed,with A point dose at ~12-24 Gy/2-4 times (C + R group). Patients in R group were only given radiotherapy. Both groups of patients received radical hysterectomy two weeks after radiotherapy. Results The tumor regression rate of C+R group was 97.1%, significantly higher than 79.0% in R group(P0.05). Postoperative pathologic examinations showed the percentage of cervical tumor residue, parauterine invasion,pelvic lymph node metastasis in C+R group was lower than those of R group(P
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Objective To evaluate the effect of intraoperative placement of super-selective intraarterial pump and postoperative regional infusion chemotherapeutics for the treatment of laparotomy proved inoperable advanced gastrointestinal cancer. Methods Intraoperatively the major artery supplying the tumor was identified and cannulated with the placement of a pump. Postoperative regional chemotherapy was carried out in 79 cases of gastrointestinal cancer. Among them there were 42 cases of gastric cancer, 37 of colorectal cancer. Results Complete tumor remission was achieved in 1 case, partial remission in 69 cases. This therapy also enabled second stage tumor resection in 11 cases. The total effective rate reached 88.6%. The 1-, 2-, and 3- years' survival rates were 84%,28% and 9%, respectively, averaging the survival period at 20.6 months. Conclusion Super-selective intraarterial pump-insertion and postoperative regional chemotherapy is effective in the treatment of advanced inoperable gastrointestinal cancer.
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Objective To investigate the effects of preoperative selective gastric arterial chemoembolization on the tumor vasculature in patients with gastric carcinoma.Methods 40 patients with gastric cancer were divided into two groups :(1)gastric arterial influsion(GAI)group;and (2)gastric arterial chemoembolization(GAE)group.The peripheral vein plasma tumor necrosis factor(TNF ?) and thrombomodulin(TM)were determined before radiologic intervention(RI),and1d,3d after R1;and the gastric vein plasma TNF ? and TM were also determined during operation.The curative surgical resection of gastric cancer was performed between 7 and 10 days after treatment.Stomach histological alterations were observed postoperatively.Results Compared with GAI group ,the plasma TNF ? levels increased markedly at all the time points,and gastric vein plasma TM levels decreased siginificantly in GAE group (P
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Objective To study the effect of preoperative selective arterial infusion chemotherapy (PSAIC) on large intestine cancer. Methods 63 patients with colorectal cancer underwent PSAIC with 5 fluorouracil,mitomycin and E adriamycin; the changes of clinical manifestation and pathology were observed and analyzed. Results (1)clinical manifestation:abdominalgia relieved in 18 patients and abdominal distention relieved in 16 patients.Improvement of hematochezia was found in 7 patients.In addition, of 13 patients with partial ileus, the clinical symptoms relieved in 9 patients. (2) pathology: there were karyopyknosis,karyorrhexis,coagulation and necrosis of cytoplasm in cancer cells. infiltration of inflammatory cells, edema and fibroelastosis in mesenchyne of cancer tissue. Proliferous intima and thrombus were also observed in the vessels. Most of these changes were moderate,and marked changes could also be seen in necrosis of cytoplasm and vessel intima proliferation. Conclusion PSAIC can control the focus of primary disease and the micrometastatic foci as well as improve the clinical symptoms, such as intestinal obstruction, and hematochezia, so PASIC is helpful to subsequent operation,and can improve the survival rate of patients with colorectal cancer.
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Objective To evaluate the effect of local arterial infusion (LAI) of medicine on the treatment of servere acute pancreatitis(SAP). Methods The clinical data of 85 cases of SAP were retrospectively analyzed, and divided into three groups according to the admitted time:Group A. 42 cases admitted from February 1982 to December 1993,treated mainly by operation. Group B. 23 cases, admitted January 1994 to Auguest 1996, treated mainly by non operation. Group C. 20 cases, from September 1996 to Auguest 2000. treated mainly by LAI. Results The secondary infection rate in group A, B and C were 47%(20/42),26%(6/23) and 10%(2/20) respectively. The mortality in group A ,B and C were 36%(15/42),22%(5/23) and 5%(1/20),respectively. The difference in the secondary infection rate and mortality between group A , B and group C showed obvious significance (P
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Objective To investigate the pathological and clinical effects of preoperative intra arterial infusion chemotherapy for patients with advanced breast cancer.Methods The clinical data of 52 patients with advanced breast cancer were analyzed retrospectively.Twenty two patients were treated with preoperative intra arterial infusion chemotherapy (treatment group),and 30 were treated without preoperative intra arterial infusion chemotherapy (control group).Results In the treatment group,the tumour size reduced and symptoms relieved after intra arterial infusion chemotherapy in 86.4% of the patients.Pathological examination of the specimens showed that raryopyknosis,raryorrhexis,cytoplasm coagulation and necrosis in cancer cells around the vascular vessels were found in all patients.Interstitial edema,inflammatory cells infiltration ,fibroelastosis around the cancer cells,proliferous intima thrombus and inflammation of vessels were also found.But in the control group,the histological chang of cancer cell was not found yet.All patients were followed up for 2 to 7 years.Local recurrence rate in the treatment group was 13.6%, while that of the control group was 33.3% (P
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Objective To study the effect of regional arterial chemotherapy (RACT) on unresectable gastric carcinoma (URGC). Methods The clinical data of 100 patients with URGC treated by RACT were retrospectively analysed. Results In addition to different degree of symptoms improvement, the size of gastric cancer became smaller in 81 2% of the cases, and the survival time of patients had been prolonged (mean 29 5 months). Conclusions RACT is more effective for treating URGC and worthly of further clinical study.
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Objective To evaluate the effect of intra-arterial infusion of basic fibroblast growth factor(bFGF) on improving neovascularization, vascular perfusion and the function of partially ischemic limbs of rabbits. Methods Twenty-seven New Zealand male rabbits were selected. Partial ischemia model was induced by surgical ligation of the primary branches of right femoral artery in each animal, and the left hind limb of each animal was served as a nonischemic control. Then, 27 rabbits were randomly assigned to three groups: intra-arterial (IA) infusion of bFGF (n=9), intravenous (IV) infusion of bFGF and IA infusion of saline (n=9). Infusion was separately performed immediately after vascular ligation, 8th and 15th days post-surgery with 10 ?g (4 ml) of bFGF per-time (or the same volume of saline). The differences between three groups and between ischemic and nonischemic limbs of the same group were compared and evaluated by the following indexes: (1) vessel section count (VSC), vessel section surface area (VSS) and vessel section perimeter (VSP) in the field of ischemic muscle tissues taken at 22nd day postoperatively; (2) capillary refilling time of ischemic limbs; and (3) functional and trophic changes of ischemic limbs. Statistical differences were evaluated by one-way ANOVA and T test. Results VSC, VSS and VSP of the IA-bFGF group were significantly increased than those of the IV-bFGF and IA-saline groups (P