Ultrasound-guided compression repair for iatrogenic femoral artery pseudoaneurysm / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate relative factors affecting the efficiency of ultrasound-guided compression repair in iatrogenic femoral artery pseudoaneurysm.</p><p><b>METHODS</b>Ultrasound-guided manual compression was performed in 42 patients of iatrogenic femoral artery pseudoaneurysm from June 2004 to June 2010. There were 28 male and 14 female patients, with a mean age of (52 ± 5) years. These patients were presented with femoral artery pseudoaneurysm after catheterisation procedure by percutaneous femoral artery puncture and confirmed by color doppler flow image. Ultrasound-guided manual persistent compression with probe was performed at the puncture site between femoral artery and pseudoaneurysm, until completely thrombosis of pseudoaneurysm, whereas the pseudoaneurysm failed to complete closure required surgical repair.</p><p><b>RESULTS</b>Out of 42 patients, 34 patients (81.0%) were successfully treated by compression resulted in completely thrombosis. There were 8 (19.0%) failures conversion to surgery. Factors associated with success were size of pseudoaneurysm (< 25 mm, 25 - 40 mm, > 40 mm; χ(2) = 13.956, P = 0.001), anti-coagulation status (χ(2) = 5.578, P = 0.010), depth of artery break (< 50 mm, 50 - 80 mm, > 80 mm; χ(2) = 14.055, P = 0.001), pseudoaneurysm communicated with common femoral artery, superficial femoral artery and profunda femoral artery (χ(2) = 8.968, P = 0.011), as well as days to presented with pseudoaneurysm (< 3 d, ≥ 3 d; χ(2) = 5.733, P = 0.012). In multivariate Logistic regression analysis, success by compression was associated with size of pseudoaneurysm (WALD = 5.34, P = 0.021) and with depth of artery break (WALD = 4.84, P = 0.028).</p><p><b>CONCLUSION</b>The ultrasound-guided compression repair of iatrogenic femoral artery pseudoaneurysm is safe, convenient, inexpensive and reliable treatment.</p>

Clinical analysis of 63 cases with gastric gastrointestinal stromal tumors / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To analyze the clinicopathological characteristics of gastric gastrointestinal stromal tumors (gastric GISTs) and to explore the diagnosis, treatment and prognosis of gastric GISTs.</p><p><b>METHODS</b>Clinical data of 63 cases with gastric GISTs from January 1997 to May 2007 were analyzed retrospectively. All patients were treated by surgery. All the 63 cases were grouped according to the Fletcher 4-tier system for predicting the aggressiveness of GISTs. Survival was calculated by Kaplan-Meier method. Univariate and multivariate analyses were performed using log-rank analysis and Cox regression model respectively to evaluate the prognostic factors.</p><p><b>RESULTS</b>The accuracy of preoperative ultrasonography, CT and EUS was 72.2%, 81.0% and 94.3% respectively. The diagnostic accuracy of EUS was significantly higher than those of ultrasonography and CT(chi(2)=6.065, P<0.05). Of the 63 gastric GISTs, 31 cases(49.20%) were at fundus. Immunohistochemistry staining revealed that the positive rates of CD117 and CD34 were 88.9% and 95.1% respectively. The 1-, 3- and 5-year total survival rates of 63 patients were 96.4%, 84.7% and 71.7% respectively. Univariate analysis revealed that the differences of Fletcher classification and tumor size were significant. No significant differences in gender, age, mitotic index, immunohistochemistry expression and multi-organ resection existed among the groups. Multivariate analysis demonstrated that Fletcher classification was the independent poor prognostic factor for survival.</p><p><b>CONCLUSIONS</b>The preoperative diagnostic accuracy of EUS is significantly higher than those of ultrasonography and CT. Fletcher classification is reasonable and feasible to evaluate the prognosis of gastric GISTs.</p>

Role of contrast-enhanced ultrasound in the differentiation of solid focal lesions of pancreas / 中国医学科学院学报

<p><b>OBJECTIVE</b>To investigate the value of contrast-enhanced ultrasound in the differential diagnosis of solid focal lesions of pancreas (s-FLPs).</p><p><b>METHODS</b>We retrospectively analyzed the clinical data of 56 s-FLPs examined with contrast agent combined with low mechanical indicators contrast-enhanced ultrasound.</p><p><b>RESULTS</b>The surrounding pancreas parenchyma enhancement time, lesion enhancement time, and peak enhancement time between different groups of s-FLPs had no significant differences (P > 0.05), while the beginning to peak enhancement time showed significant difference (P < 0.05). When using the enhancement speed as a diagnostic indicator to differentiate pancreatic carcinoma from tumor-like pancreatitis, the sensitivity, specificity, and accuracy were 90.5%, 71.4%, and 85.7% for pancreatic carcinoma and 75.0%, 91.7%, and 89.3% for tumor-like pancreatitis. When using the enhancement pattern as a diagnosis indicator to differentiate pancreatic carcinoma from tumor-like pancreatitis, the sensitivity, specificity, and accuracy were 85.7%, 78.6%, and 83.9% for pancreatic carcinoma and 75.0%, 100%, and 94.6% for tumor-like pancreatitis. When different indicators were combined, enhancement pattern and enhancement speed showed the best diagnostic results; however, the Youden index was not improved.</p><p><b>CONCLUSIONS</b>Different s-FLPs show different enhancement findings on contrast-enhanced ultrasound. The enhancement pattern and enhancement speed are the most useful diagnostic indicators.</p>

Characterization of focal liver lesions using an innovative contrast-enhanced ultrasound technique / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the clinical performance of an innovative contrast-enhanced ultrasound (CEUS) technique in characterization of focal liver lesions (FLL).</p><p><b>METHODS</b>CEUS was performed in 505 patients with FLLs. A sulfur hexafluoride-filled microbubble ultrasound contrast agent and a continuous real-time imaging technique of contrast pulse sequencing were used. The observation items included initial nodule enhancement time, enhancement level and pattern, and dynamic evolution of enhancement along with the CEUS phases.</p><p><b>RESULTS</b>There were similar findings for both malignant and benign FLLs in initial enhancement time and enhancement level on CEUS. The dynamic evolution of enhancement along with enhancement phase was the most significant parameter for characterization of FLLs. Most malignant lesions showed enhancement at arterial phase and hypo-enhancing at late phase, whereas the benign lesions presented enhancement at arterial phase and persistent hyper- or iso-enhancing until late phase. Using these characteristics as a diagnostic criteria, the sensitivity, specificity, positive predicative value, negative predicative value and accuracy of CEUS in identifying malignant FLLs were 95.7% (313/327), 86.0% (153/178), 92.6% (313/338), 91.6% (153/167) and 92.3% (466/505), respectively.</p><p><b>CONCLUSIONS</b>Characterization of FLLs by using the innovative CEUS technique is recommendable due to its safety, facility and high accuracy.</p>

Studies on the hypoglycemia and lipids regulating effects of Plantago depressa var. montata / 中国中药杂志

<p><b>OBJECTIVE</b>To investigate the effects of Pantago depressa var. montata. Extract (PDM) on the metabolisms of glucose and lipids in mice as well as the underlined mechanism.</p><p><b>METHOD</b>Fasting serum glucose (FSG) in normal mice was determined after oral administration of PDM. The effects of PDM on diabetic mice induced by alloxan were investigated by observing the changes of glucose tolerance, the contents of FSG, glycosylated serum protein (GSP), total cholesterol (TC), triglyceride (TG), low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C), superoxide dismutase (SOD), malondialdehyde (MDA), nitric oxide (NO) and the injured degree of pancreatic islet. Effects of PDM on the injured human umbilical vein endothelial cell lines (ECV304) induced by H2O2 were also investigated.</p><p><b>RESULT</b>PDM showed no any significant effect on FSG in normal mice. However, in the mice with diabetes induced by alloxan PDM could remarkably decrease serum glucose tolerance, the contents of FSG, GSP, TC, TG and LDL-C and significantly increased the ratio of HDL-C/TC, the activity of SOD and the concentration of NO. The damage of pancreatic islet induced by alloxan was also significantly attenuated by PDM. Furthermore, PDM promoted the viability of injured ECV304, elevated SOD level and reduced the contents of MDA.</p><p><b>CONCLUSION</b>The results in the present study suggest that PDM can significantly attenuate hyperlipidemia and hyperglycemia in diabetic mice, which are probably due to its effects of antioxidation and amelioration of damaged pancreatic islet induced by free radicals.</p>