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Objective To explore clinical implications of pleural effusion in thoracic endovascular aorta repair (TEVAR) of type B aortic dissection.Methods Clinical data of 28 patients (23 males,5 females) hospitalized from Jan 2015 to Dec 2016 were analyzed retrospectively.There were ruptured aortic dissection (RAD) (n =7) and the contained aortic dissection (CAD) (n =21).26 patients underwent TEVAR,and two patients received conservative treatment.Results 26 patients received TEVAR and operations were successful.2 patients treated conservatively died.Six patients had bilateral pleural effusion,while 20 had left pleural effusion and two had right pleural effusion.The distribution of pleural effusion was significantly different between CAD and RAD group (x2 =10.4,P ＜ 0.05),and the rupture risk was the highest in right sided pleural effusion.The median volume of pleural effusion on right side in RAD group are higher than that in CAD group (Z =-3.293,P =0.001).One patient died of sudden death on post-op 9th day.Pleural effusion disappeared in all 24 patients who were followed-up for more than 3 months.There were no ensuing pleural thickening,pulmonary atelectasis,and lung consolidation.Conclusious Pleural effusion on left side are common in type B aortic dissection,while bulk right pleural effusion may indicate impending rupture.Endovascular therapy is a feasible,safe and effective therapy for aortic dissection with pleural effusion.
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Aortic dissection (AD) is one of the disastrous cardiovascular diseases.Due to the uncertain,varied clinical manifestations of the AD,clinical misdiagnosis or missed diagnosis may occur occasionally.Doctors should carefully and thoroughly evaluate clinical manifestations,and raise awareness and vigilance on acute AD.After suspecting or diagnosing acute AD,specialists of vascular surgery should be contacted as soon as possible so that they could successfully treat patients.By briefly describing the different clinical manifestations of the AD in various human systems,this paper aims to promote the recognition of the atypical AD.
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Objective To investigate the features of time distribution in the onset of aortic dissection (AD).Methods The retrospective cross-sectional study was conducted.The clinical data of 476 AD patients who were admitted to the First Affiliated Hospital of Anhui Medical University from January 2009 to June 2017 were collected.The patients were divided by the following criteria:gender,age [youth(＜45 years),middle-age (45-59 years) and elderly (≥ 60 years)],Stanford types (type A and type B),with or without hypertension.All variables were analyzed by circular distribution statistics to illuminate the features of time distribution in the onset of AD (monthly rhythm and circadian rhythm).Observation indicators:(1) overall time distribution of AD;(2) time distribution of subgroups with different genders;(3) time distribution of subgroups with different age;(4) time distribution of subgroups with different Stanford types;(5) time distribution of subgroups with or without hypertension.Measurement data with normal distribution were represented as (x)±s and count data were described as constituent ratio.The circular distrbution statistics were used to calculate time data of onset after trigonometric function transformation.The monthly rhythm and circadian rhythm were done using the Rayleigh test (Z value).Results (1) Overall time distribution of AD:the AD patients had the monthly rhythm and circadian rhythm (Z=14.79,31.60,P＜0.05).The months with the maximum and minimum cases were November (59 cases) and August (24 cases) respectively,the peak day was on January 12.AD often occurred from 16:00 to 17:00 (37 cases) but barely occurred from 3:00 to 4:00 (8 cases),with a peak of 14:55.(2) Time distribution of subgroups with different gender:male subgroup had the monthly rhythm and circadian rhythm (Z =11.28,27.81,P＜0.05);female subgroup had the monthly rhythm and circadian rhythm (Z=3.48,4.37,P＜0.05).(3) Time distribution of subgroups with different age:patients in the youth subgroup had no monthly rhythm (Z=1.33,P＞0.05),and there was the circadian rhythm (Z=4.29,P＜0.05);patients in the middle-age subgroup had the monthly rhythm and circadian rhythm (Z =7.48,17.41,P＜0.05);patients in the old-age subgroup had the monthly rhythm and circadian rhythm (Z =6.62,11.04,P ＜ 0.05).(4) Time distribution of subgroups with different Stanford type:patients inthe type A subgroup had no monthly rhythm (Z=1.60,P＞0.05),and there was the circadian rhythm (Z=10.51,P＜0.05);patients in the type B subgroup had the monthly rhythm and circadian rhythm (Z=13.94,21.70,P＜0.05).(5) Time distribution of subgroups with or without hypertension:subgroups with hypertension had the monthly rhythm and circadian rhythm (Z =12.08,29.81,P＜ 0.05).Subgroups without hypertension had no monthly rhythm (Z=3.84,P＞0.05),showing a statistically significant difference in the circadian rhythm (Z=4.78,P＜0.05).Conclusion AD often occurs in cold months and afternoon.
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Objective To evaluate outcomes of endovascular procedures for atherosclerosis obliterans (ASO) patients with diabetes mellitus (DM).Methods Data of patients undergoing endovascular procedures for atherosclerosis obliterans at the First Affiliated Hospital of Anhui Medical University from January 2012 to December 2014 were retrospectively analyzed,disease characteristics,technical success rate,perioperative complications,ankle brachial index (ABI) improvement,clinical success rate,rest pain alleviating rate,limb salvage rate and survival rate were compared between the two groups.Results There were 144 patients (153 limbs) who received endovascular procedures,including 52 patients (56 limbs) with DM and 92 patients (97 limbs) without DM.Mean follow-up was 15 months.All patients experienced significant ABI improvement (P ＜ 0.05).There was no significant difference in technical success rate (80.4％ vs 90.7％),perioperative complications rate(19.6％ vs 24.7％),1 year rest pain alleviating rate (75.0％ vs 85.6％),1 year limb salvage rate (91.1％ vs 95.6％) and 1 year survival rate (92.3％ vs 90.2％) between diabetic and non-diabetic groups (P ＞ 0.05),but there was less 1 year clinical success rate in diabetic group (78.6％ vs 88.6％,P ＜ 0.05).Conclusions Compared to nondiabetic paitents,endovascular procedures for patients with DM has similar efficacy,when the procedures are properly undertaken and postoperative correct medication are given.
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Objective To study the correlation between male primary varicose vein of the lower extremity and varicocele.Methods 100 male patients with varicose vein of the lower extremity were compared with 100 male adults without varicose vein of the lower extremity for the prevalence of varicocele by using ultrasonography.Results There is no difference of demographic data between the two groups (t =1.78,P ＞ 0.05).There were 49 (49.0％) patients found with varicoele in study group compared with 19 (19.0％) patients with varicoele in control group (x2 =20.05,P ＜ 0.01).We compared the rate of varicoele and the mean diameter of spermatic vein between the patients having reflux in the saphenofemoral junction or not,and found there was no statistical difference between themn (rate of varicose P ＞ 0.05,diameter P ＞ 0.05).In patients with both lower extremity varicose vein and varicocele there was a linear correlation between spermatic vein diameter and that of varicose vein (rs =0.407 2,P ＜ 0.01).When patients in study group were classified into six grades by Clinical-Etiology-Anatomy-Pathophysiology (CEAP) trend chi-square found no difference in the incidence of varicoele (x2 =0.879 8,P ＞ 0.05),nor the mean diameter of spermatic vein in different grades (F =1.59,P ＞ 0.05).Conclusion There is a correlation between varicose vein of the lower extremity and the pathogcnesis of varicocele.
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Standard endovascular repair of iliac/aortoiliac pathologies can lead to complications, such as buttock claudication, colon ischemia and erectile dysfunction. Branch grafts have been developed but require at least 6 weeks for customization and are not currently available in China; they are also quite expensive. To our knowledge, modified fenestrated stent grafts (MFSGs) are a safe and effective alternative for treating patients with juxtarenal aneurysms. Most MFSGs are used for the preservation of renal and left subclavian arteries. Few cases of MFSGs have been reported in the treatment of iliac pathologies. The use of an MFSG is decided on a case-by-case basis. This report presents our first clinical use of an MFSG for preservation of the internal iliac artery.
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Humanos , Masculino , Aneurisma , Prótesis Vascular , Nalgas , China , Colon , Disfunción Eréctil , Arteria Ilíaca , Isquemia , Patología , Stents , Arteria Subclavia , TrasplantesRESUMEN
Objective To detect attenuated plaque by using intravascular ultrasound (IVUS) in patients with acute myocardial infarction (AMI) and to investigate the influence of attenuated plaque on perioperative period of percutaneous coronary intervention (PCI). Methods Coronary angiography and IVUS were performed in 85 hospitalized patients with AMI, additional implantation of stent was employed when necessary. According to the presence or absence of attenuated plaque determined by IVUS, the patients were divided into attenuated plaque group(n=35) and non-attenuated plaque group(n=50). The perioperative IVUS findings, the blood flow classification after myocardial infarction thrombolysis (TIMI) and the postoperative peak value of creatine kinase MB (CK-MB) determined were compared between the two groups. Results Among the 85 AMI patients, attenuated plaque was detected in 35 (41.2%) and no attenuated plaque was found in 50(58.8%). No statistically significant differences in the age, sex and risk factors existed between the two groups (P>0.05). The proportion of having attenuated plaque in patients with ST segment elevation myocardial infarction (STEMI) was obviously higher than that in patients with non-STEMI (P0.05), but after balloon dilatation the TIMI grade 0-2 in theattenuated plaque group was strikingly higher than that in the non-attenuated plaque group (P=0.003). After PCI, the proportion of patients with elevated CK-MB value and higher peak value in the attenuated plaque group was remarkably higher than those in the non-attenuated plaque group (P<0.01). Conclusion The results of this study indicate that attenuated plaque can increase the incidence of no-reflow and slow reflow after PCI, which is more often seen in STEMI patients. The attenuated plaque carries significantly high risk, and the presence of attenuated plaque is helpful in predicting, the elevated extent of CK-MB value after PCI.
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Objective To investigate the early diagnosis and rational treatment of popliteal artery injury so as to im-prove the lower limb salvage rate. Methods The clinical and follow-up data integrity of 25 patients with popliteal artery injury was systematically studied. In these patients , 19(76%)cases were blunt injury and 6(24%) cases were penetrating injury. The combined injury included open fracture in 10 cases(40%) ,the knee joint dislocation with closed fracture of lower limb in 13(52%),nerve injury in 5(20%) and venous injury in 3(12%),respective-ly. The cause of delayed diagnosis and relationship between prognosis and type of injury, complications, the dura-tion from injured to treatment time were analyzed. Results 20 cases were operated to repair the popliteal artery. Endovascular treatment in 5 cases, the blood supply completely recovered (64%) in 16 cases, improved in 3 cases (12%) , 6 cases (24%) amputed, respectively. Rate of amputation within 6~8 hours was significantly lower than that of the more than 8 hours from the injuried to treatment time ( P<0. 05 ) . Amputation rate in blunt injury and combined injury was significantly higher than that of sharp injury ( P<0. 05 ) . Conclusion The duration from inju-ry to surgery more than 8 h, combined with knee joint dislocation and wound around knee is a major cause of mor-bidity. Operation with arterial thrombectomy is the main treatment, while endovascular treatment is a complementa-ry treatment to save the lower limb.
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<p><b>OBJECTIVE</b>To explore the value and safety of the application of enteral nutrition in pediatric surgery.</p><p><b>METHODS</b>Clinical data of 56 children patients who could not undertake oral feeding or those who required enteral nutrition by nasojejunal tube over 7 days in our ward from June 2007 to May 2013 were retrospectively analyzed. Children younger than one year old received enteral nutritional formulation Ai Er Shu mainly composed of short peptides or amino acids, and children over one year received Small peptide or Nengquansu mainly composed of short peptide.</p><p><b>RESULTS</b>Among these 56 children patients, primary disease was pancreatitis in 20 cases, lacerated wound in 10, duodenal perforation in 6, duodenal septum-shape stenosis in 9, annular pancreas in 6, and hepatoblastoma in 5. All the patients successfully completed the enteral nutrition therapy within 7-37 (18±9.9) days with good recovery. During the treatment, 5 cases (8.9%) developed diarrhea, 3 cases (5.4%) nausea and vomiting, 2 cases (3.6%) mild abdominal distension, 5 cases(8.9%) mild abdominal pain, and the symptoms were relieved after adjustment of nutrient solution concentration and infusion rate. After enteral nutrition for 10 days, the nutritional status of children was improved, and weight, blood red cell count, hemoglobin, serum albumin, prealbumin increased significantly (P<0.05).</p><p><b>CONCLUSION</b>Application of enteral nutrition in pediatric surgery is safe and effective, which can improve the nutritional status of children and promote the recovery.</p>
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Niño , Humanos , Lactante , Dolor Abdominal , Diarrea , Nutrición Enteral , Estado Nutricional , Páncreas , Anomalías Congénitas , Enfermedades Pancreáticas , Pancreatitis , Estudios RetrospectivosRESUMEN
Objective To explore the effect and technical consideration of placement of inferior vena cava filter (IVCF) in the treatment of low extremity deep venous thrombosis (DVT).Methods From Jun 2011 to Jun 2013,73 consecutive DVT cases were for IVCF placement.There were 47 males and 26 females with a mean age of (51 ± 23) years (ranging from 36 to 80 years).Results Procedures were successful in 70 out of 73 cases.There were 18 permanent and 52 temporary IVCFs deployed.The indications for filter insertion were pulmonary embolism (PE) (25 cases,34％),perioperative prophylactic implantation (18 cases,24％),contraindication to anticoagulation therapy (15 cases,20％) and iliofemoral vein thrombosis(10 cases,13％).17 filters were successfully removed with a successful rate of 33％.After the follow-up of mean 24 months (4 to 36 months) of 68 patients,no pulmonary embolism occurred,but symptomatic DVT recurred in 5 patients,and the conditions were improved after anticoagulation treatment.No serious complication of post thrombotic syndrome occurred.Conclusions IVCF placement is effective for prevention of PE,when the therapeutic indications and contraindications are properly controlled.
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Objective To investigate the seasonal variability of the onset of acute deep vein thrombosis(DVT).Methods The clinical manifestations in 774 DVT patients during January 2008 to December 2012 were collected and circular distribution statistics was used to identify seasonal variability.Results The total sample had the significant seasonal variability (P ＜ 0.01):DVT was most frequent in winter while less frequent in summer and the peak day was January 1.Female subgroup has significant seasonal variability (P ＜0.01):on peak in winter and at trough in summer while male subgroup has no significant seasonal variability (P ＜ 0.01).Different age subgroups (＜ 40 years,40-69 years,＜70 years)have significant seasonal variability(P ＜ 0.05,P ＜ 0.01,P ＜ 0.01).DVT was most common in December and less frequent in August.Left lower limb subgroup and both lower limb subgroup has significant seasonal variability (P ＜ 0.01,P ＜ 0.01),on peak in December-January.Immobilization subgroup also has significant seasonal variability (P ＜ 0.001):frequent in winter,January 1 is on the peak.Conclusions DVT has significant seasonal variability in onset:it is most frequently seen in winter while less frequent in summer.Some subgroups (female,＜70 years and immobilization) have the most significant seasonal variability in onset.
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Objective To determine whether the presence of coronary collateral lfow, as evidenced by angiography, has a beneifcial effect on left ventricular function in ST-segment-elevation myocardial infarction (STEMI) treated by means of early percutaneous coronary intervention (PCI). Methods Between April 2012 to November 2013, 95 patients with STEMI treated with primary PCI successfully were analyzed. According to the Rentrop grade, these patients were divided into 2 groups:collateral circulation group (n=16) and non-collateral circulation group (n=79). The left ventricular function was evaluated within 24 hours after PCI and 30 days later. Results Comparison of 2 groups showed that collateral lfow was associated with better left ventricular ejection fraction within 24 hours and 30 days after PCI. And non-collateral lfwa was associated with more ventricular aneurysm formation. Conclusions The presence of angiographically detectable collaterals has a protective effect on left ventricular function in ST-segment-elevation myocardial infarction (STEMI) treated by primary PCI.
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Objective To compare the clinical efficacy of catheter directed thrombolysis(CDT ) ,thrombectomy(ST ) and system‐atic anticoagulant(SA) in treating acute iliofemoral deep vein thrombosis(AIFDVT ) of lower limb using Meta analysis method . Methods The systematic review was initialted by electronic literature searches (PUBMED ,MEDLINE ,ELSEVIER ,etc .) for stud‐ies comparing catheter directed thrombolysis ,thrombectomy and systematic anticoagulant clinical effects published from January 1984 to January 2014 based on the keyword such as iliofemoral deep vein thrombosis;thrombolysis;anticoagulant therapy ;throm‐bectomy ;RCTs;Meta analysis.A Meta analysis was conducted to estimate early vein patency ,post thrombotic syndrome(PTS) , venous reflux(VR) rate ,venous obstruction(VO) rate ,etc .Results Ten RCTs were included in this analysis ,including 626 pa‐tients .The early vein patency rate was higher in the CDT group and the difference was statistically significant(OR=4 .61 ,95% CI 1 .93-10 .98 ,P0 .05) .The post thrombotic syndrome rate was less both in the CDT group(OR=0 .18 ,95% CI 0 .07 -0 .43 ,P0 .05) .Conclusion For acute iliofemoral deep vein thrombosis(AIFDVT) , short term (6 m) outcomes ,the post thrombotic syndrome rate was less both in the thrombolysis group and the thrombectomy ,and catheter directed thrombolysis could diminish the vein obstruction rate .
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Varicose vein of lower extremity and varicocele show tortuosity,dilatation in different parts of venous.They are linked in venous anatomy structure.Their pathogenesis are not clear,but have certain similarity in venous wall structures,venous pressure,venous valvular incompetence,venous insufficiency,level of serum sex homone and apoptosis.We review the related literature to investigate the correlation between pathogenesis of them,in order to provide reference for the etiology,diagnosis and treatment.
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ObjectiveTo study the effect of platelet aggregation rate (PAR) level on the prognosis of percutaneous transluminal coronary angioplasty (PCI).MethodsFour hundred and one patients who performed PCI were divided into 4 groups:group 1 (PAR≤30％,103 cases),group 2 (PAR 31％ - 40％,102 cases),group 3 (PAR 41％ - 49％,103 cases ) and group 4 (PAR ＞ 49％,93 cases ).All the patients were followed up.The survival analysis was performed in 4 groups.ResultsThe data of survival table were tested by 3 methods among 4 groups:statistic was 0.612,degree of freedom was 3,P =0.894 in Log-rank (Mantel-Cox) test,statistic was 0.567,degree 9f freedom was 3,P =0.904 in Wilcoxon test and statistic was 0.586,P =0.900 in Tarone-Ware test.There was no significant difference among them.The mean follow-up duration was 2.2 years,and there was no significant difference in survival function among 4 groups (P ＞0.05).ConclusionPreoperative and postoperative measurement of PAR levels may not improve the prognosis.
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Objective To evaluate the therapeutic effect and security of triple antiplatelet with cilostazol in the elderly after drug-eluting stent implantation and compare it with double antiplatelet treatment. Methods 234 elderly patients with coronary disease were randomly divided into two groups.118 cases in the triple antiplatelet group were treated with clopidogrel (300 or 600 mg/d) and aspirin(100 mg/d) in addition with cilostazol(200mg/d) from pre surgery to 6 month after surgery,then received double antiplatelet treatment.116 cases in the double antiplatelet group were treated with Aspirin(100 mg/d) and clopidogrel(300 or 600 mg/d),then clopidogrel was ceased after 1 year and used only Aspirin. The main parameters during follow up included all-cause death,major adverse cardiovascular events (MACE) and major adverse cardiac and cerebrovascular event (MACCE),the secondary parameters during follow- up were recurrence of angina pectoris,myocardial infarction,revascularization and hemorrhage within 2 years. Results The recurrence of angina pectoris and revascularization were found in 1 case (0.85％) and 1 case(0.85％) respectively in the triple antiplatelet group,while 8 cases(6.90％) and 8 cases (6.90％) in the double antiplatelet group,with significant difference between the two groups(both x2 =4.27,P＜0.05).All cause death,myocardial infarction,cerebral apoplexy and hemorrhage were not found in the triple antiplatelet group,while 1 case of death,1 case with myocardial infarction,1 case with apoplexy and no hemorrhage appeared in the double antiplatelet group,with no significant difference between the two groups(P＞0.05).Conclusions The triple antiplatelet added with cilostazol in the elderly after drug eluting stent implantation may decrease the recurrence of angina pectoris and revascularization with higher security.
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Varicose veins is the main clinical manifestations of the chronic venous insufficiency.TIPP transilluminated powered phlebectomy,a new minimally invasive surgery,received much attention while surgical techniques aimed at treating varicose vein were constantly updated.In this article,TIPP in the varicose vein surgery is reviewed from its history,operating techniques and advantages,and TIPP's future is being prospected.
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Calcium-sensing receptor(CaSR)is expressed in human parathyroid cells and renal tubular epithelial cells mainly.CaSR could control parathyroid hormone(PTH)secretion and the renal tubular's handing of the electrolytes and water.This receptor plays a central role in extracellular calcium homeostasis,and involves in the process of bone remodeling.The change of CaSR function,including anti-CaSR antibodies,CasR gene mutations or any part impairment in CaSR signaling pathway,not only results in the imbalaance of PTH and calcium homeostasis.but also relates to disorders of bone remodeling and renal tubular's mishandling in the electrolytes and water,which contribute to hyperparathyroidism.It makes possible clinical Use of cinacalcet in hyperparathyroidism in theory.
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Objective To evaluate the effect of different regimens of antiplatelet drugs on the major adverse cardiac events (MACEs) in elderly patients undergoing selected percutaneous coronary intervention (PCI) in direction of the adenosine diphosphate (ADP) -induced platelet aggregation index. Methods The 1230 cases aged 60-80 years, mean (67. 2±10. 2) years undergoing selected PCI with the drug eluting stent were enrolled. The 615 cases of the ADP guided group according to the ADP-induced platelet aggregation index. After the first loading dose of clopidogrel (300 mg) , once the decrease of ADP-induced platelet aggregation index was more than 50% as compared with the basic level, the dose of 75 mg each day would be maintained for one year. If the decrease of the index was less than 50%. the another 300 mg of clopidogrel would be given again, until up to 900 mg on the 3th day. If the decrease of the index was still not enough, the combination of clopidogrel 75 mg, cilostazol 100 mg and aspirin 100 mg each day would be suggested. The rest 615 patients in the routine dosage group took the routine dose of clopidogrel (the first loading dosage 300 mg was taken, then 75 mg each day for one year ) . The MACEs, including cardiac death, myocardium infarction, revascularization and stent thrombosis, were observed for 12 months. Results After the first 300 mg of clopidogrel, only 45% of patients reached the standards. Until reaching 900 mg, 67.5% of patients in the ADP guided group were eligible. The tailored clopidogrel loading dose in the ADP guided group yielded a better effect on the inhibition of platelet aggregation (the routine dose vs. the tailored loading dose: 45% vs. 67. 5% , P=0. 028). After one year follow up, the MACEs were less in ADP guided group than in routine dosage group (2. 8% vs. 4. 9% , P = 0. 035). All of patients had no major bleeding, and the minor bleeding and other drug adverse events in two groups had no significant differences. Conclusions The patients undergoing selected PCI should receive ADP -induced platelet aggregation test in order to assess the inhibition effect of clopidogrel on the platelet aggregation. It is safe and effective to modify the antiplatelet drugs regimen during the peri-PCI procedure in direction of ADP-induced platelet aggregation.
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Objective To discuss rational diagnosis and treatment of acute infrarenal abdominal aortic occlusion. Methods Retrospective analysis was made on 6 cases with acute infrarenal abdominal aortic occlusion from January 2005 to December 2008. Emergency operations of retrograde catheter were done on 3 cases, 2 cases received transaortic embolectomy, 1 case received anticoagulation therapy successfully. Results Two cases were cured, 2 cases with 3 legs received amputation, 2 cases died. The time in hospital was 4 hours to 122 days, averaged (24±55) days. Conclusions A prompt thrombolytic, anticoagulation therapy and operation are suggested. It is emphasized to prevent reperfusion injury after arterial ischemia during the peri-and post-operation. Conservative treatment may be used in the patients incorporated with seriously multiple organ failure.